The role of ultrasound in the visualization of the ingested medications in acute poisoning - a literature review

In the patients with medication poisoning, diagnosis and treatment may be complicated due to the decreased level of consciousness or lack of the patient cooperation. In this review, we tried to assess the role of ultrasonography in detection of the ingested medication in the stomach of the patients with suspected medication poisoning. Of the studies performed in this regard, only one managed to determine the extended phenytoin capsules in the stomach of a poisoned patient. In actual acute poisoning - even in the hands of an experienced ultrasonographer - detection of the medications in the patients' stomach seems to be difficult due to the presence of the food or lack of the water in their stomach. Also, after dissolution of the tablets or capsules or their passage from the pylorus, they can not further been visualized by ultrasound. We, therefore, conclude that ultrasonography is not an appropriate tool for diagnosis of the medication ingestion in acute poisoning.

Lipid emulsion improves Glasgow coma scale and decreases blood glucose level in the setting of acute non-local anesthetic drug poisoning--a randomized controlled trial

BACKGROUND

To date, no study has been performed to evaluate the antidotal effect of intravenous lipid emulsion on the poisoned patients' level of consciousness and routine metabolic profile tests in non-local anesthetic drug overdose.

OBJECTIVES

Our aim was to evaluate the effect of intravenous intralipid administration as an antidote on the poisoned patients' Glasgow Coma Scale (GCS), hemodynamic parameters, arterial blood gas analysis, and routine metabolic profile tests (i.e., urea, glucose, sodium, and potassium) in the setting of non-local anesthetic drug overdose.

MATERIAL AND METHODS

In this randomized controlled trial, a total of 30 patients with non-local anesthetic drug intoxication were enrolled and randomly assigned into case (n=15) and control (n=15) groups. In the case group, all patients received 10 cc/kg intralipid 10% infusion. The patients in the control group just received the supportive care. Patients' demographic and clinical characteristics and results of their laboratory tests were evaluated at presentation and 6 hours after that.

RESULTS

Mean age was 23 +/- 5 and 28 +/- 11 years in cases and controls, respectively. There were no significant statistical differences between these two groups regarding age, gender, elapsed time between intubation and extubation, and need for intubation and/or mechanical ventilation (p = 0.70 and p = 1.00, respectively). Also, systolic blood pressure, pulse rate, mean rate pressure product, respiratory rate, results of arterial blood gas analyses, serum sodium, potassium, urea, and creatinine on presentation and six hours later were not statistically significantly different between the two study groups. However, a significant difference was found between the two groups in terms of GCS difference (p = 0.048) and blood glucose six hours after presentation (p = 0.04).

CONCLUSIONS

In the setting of non-local anesthetic drug overdose, intravenous intralipid infusion can increase GCS and interestingly, decrease the blood glucose.

Tramadol-induced seizures and trauma

BACKGROUND AND OBJECTIVES

To determine the prevalence, type and site of the injuries due to tramadol-induced seizures in the patients who had referred after its overdose or use of its therapeutic dose.

MATERIAL AND METHODS

All patients referring to Loghman Hakim Poison Hospital (February 2009 to April 2010) due to tramadol-induced seizures were included. The patients' data including age, gender, ingested dose by history, route of exposure, manner of poisoning, previous history of suicidal attempts, previous history of drug or substance abuse, history of tramadol abuse, type of the seizure, number of episodes of seizure before presentation or after admission, site of the trauma, and type of injury were recorded.

RESULTS

A total of 232 patients were included in the study. Of them, 185 (79.7%) had referred within the first 6 hours after ingestion. The mean dose ingested by the history was 1416 +/- 1124 mg. History of tramadol abuse was positive in 114 (49.1%) patients. Seizure episodes had occurred once in 207 (89.2%), twice in 21 (9.1%), and three times in 4 (1.7%) patients. The prevalence of trauma was 24.6% (in 57 patients) with the most frequent site of trauma to the face (9.5%) followed by shoulder (4.3%), head (3%), trunk (1.7%), and upper extremities (1.3%). No statistically significant difference was found between patients with and without trauma associated with tramadol-induced seizures in terms of age, gender, ingested dose by history, positive history of addiction to other opioids, and number of episodes of seizure.

CONCLUSIONS

The only serious injury associated with this type of seizure was the head injury, present in approximately 1% of the patients.

Prevalence of pituitary incidentaloma in the Iranian cadavers

AIM

Although one-fourth of the pituitary tumors are inactive and silent, increased total volume of the pituitary gland exerts pressure on sella turcica and corrodes the clinoid processes, resulting in several problems. Therefore, determination of the prevalence of the concealed pituitary tumors is of major concern among clinical practitioners. This study was performed to determine the prevalence of these tumors in cadavers referred to the Iranian Legal Medicine Organization (Kahrizak, Tehran).

MATERIALS AND METHODS

This cross-sectional descriptive study was performed between June 2007 and February 2008. A total of 485 cadavers were selected by simple random sampling method. Pituitary glands were removed and then horizontally cut and four slides were prepared from each of them, stained by hematoxylin and eosin, and evaluated by a light microscope. For statistical analysis, SPSS software (version 16), Mann-Whitney U test, Kolmogorov-Smirnov nonparametric test (K-S test), and Chi-square test were used.

RESULTS

Of the 485 investigated cadavers, 365 (75.3%) were males with an average age of 42 ± 20.5 years and 120 (24.7%) were females with an average age of 44 ± 22 years. A total of 61 (12.6%) had concealed pituitary masses. No statistically significant difference was found between the mean age, sex, and body mass index (BMI) of the cadavers with and without concealed tumors (P=0.380 P=0.450, and P=0.884, respectively).

CONCLUSIONS

In the present study, the prevalence of the concealed pituitary adenomas was 12.6%. There was no correlation between age, sex, and BMI and the prevalence of the concealed masses.

Ovarian metastasis in endometriod type endometrial cancer

BACKGROUND

The purpose of this study was to examine the rate and clinico-Pathological characteristics of ovarian metastasis of endometriod type endometrial cancer.

MATERIALS AND METHODS

A retrospective study of all patients with endometriod type endometrial cancer was carried out during 1990-2009. Chi-square and Fisher's Exact tests were used to analyze all the variables. P ≤ 0.05 was considered statistically significant. SPSS software (version 18), was used for statistical analysis of the data obtained.

RESULTS

Two hundred and ten patients fulfilled the inclusion criteria. Only 17 (8%) cases were identified to have ovarian metastasis. Fisher's Exact test showed that the independent risk factors of ovarian metastasis in endometrial carcinoma included pathologic grading and depth of myometrial invasion (p<0.001 and p<0.02, respectively).

CONCLUSION

The risk of ovarian metastasis in the patients with well to moderately differentiated endometriod type endometrial cancer and myometrial invasion limited to less than one half of the myometrium is minimal. Therefore, it is possible to preserve ovaries in young women with early stage endometrioid type endometrial carcinoma, but it is better to remove and freeze ovarian tissue to save fertility without the recurrence risk of ovarian cancer.

Epidemiological and clinical features of Brucella arthritis in 24 children

BACKGROUND AND OBJECTIVES

Brucellosis is considered the leading zoonotic disease of the Middle East. The disease has a wide spectrum of clinical manifestations and can result in complications with severe morbidity. The aim of this study was to evaluate the frequency, distribution and characteristics of arthritis in Iranian children with brucellosis.

DESIGN AND SETTING

A retrospective descriptive study conducted in a referral children center in Tehran from 1997 to 2005.

PATIENTS AND METHODS

Arthritis in children with brucellosis who were admitted to a specialized hospital was detected by clinical signs of the involved joint(s) and characteristics of joint fluid aspiration. Socio-demographic information was recorded.

RESULTS

Of 96 patients diagnosed with brucellosis, 24 (25%) had Brucella arthritis 14 (58.3%) males and 10 (41.7%) females. Most common manifestations were fever in 21 patients (87.5%) and fatigue in 18 patients (75%). Monoarthritis was recorded in 15 patients (62.5%) of the cases with involvement of the knee in 8 (45%) and hip in 5 (29%), the ankle in 2 (8%) patients while 9 (37.5%) patients suffered from polyarthritis. None of the patients had axial joints involvement. Seventy-five percent of the subjects (18 patients) were from urban areas and 66.7% (16 patients) had consumed un-pasteurized cheese. Recurrence was not seen in any of the 24 patients who received a combination of co-trimoxazole for 6 weeks and gentamicin for 5 days.

CONCLUSION

Childhood brucellosis is a challenging disease in Iran that has serious complications like arthritis. Therefore all physicians who work in endemic areas should be familiar with this disease and consider the possibility of brucellosis in all children who present with arthritis and arthralgia.

Frequency of different types of ovarian cancer in Vali-e-Asr Hospital (Tehran University of Medical Sciences) 2001-2003

Purpose of this study was to report histology specific age adjusted ovarian cancer incidence rates from 2001-2003 in Tehran University Hospital (valie-Asr hospital). This was a case series study including all microscopically confirmed cases of ovarian malignancies from 2001-2003. There were 152 cases of ovarian cancer, 102 (67.1%) epithelial type, 26 (17.1%) germ cell tumors, 14 (9.2%) sex cord stromal and 10 (6.6%) metastatic ovarian tumors. Present results were compatible with results from nonwestern countries. Epithelial type tumors and sex cord-stromal tumors were more prevalent after the age 50 (40 and 44.4% consequently). Germ cell tumors were more prevalent before 20(16 cases, 61.5%) (chi2 = 42.54, p-value = 0.000). Stage of disease in epithelial type tumors was advanced in most of patients but most germ cell tumors and sexcord-stromal tumors were stage I (chi2 = 19.6, p-value = 0.000). Present study showed that epithelial ovarian tumors in comparison to western countries are less frequent in Iran but still this histologic type is the most prevalent type of ovarian malignancy in this area of the world. Of course in younger patients we can predict more probability of germ cell tumors with more localized disease and better prognosis.

Breast cancer in Iran: a review of 903 case records

A retrospective study was carried out in five main General District and Teaching Hospitals in Tehran (18 general surgical wards) to investigate breast cancer in Tehran, Iran. All patients who have had breast pathology during 1985-95 were reviewed. For each patient the following data were extracted from case records sex, age, type of disease (based on ICD-10 and ICD-O), breast cancer pathology, tumor size, lymph node involvement, pathological staging (based on TNM system), type of surgery, mass location and the affected side of breast. In all 3085 records were reviewed. Of these, in 903 cases the final diagnosis was breast cancer. The mean age of breast cancer patients was 47.1 (SD=12.3) y and the age-adjusted analysis showed that the observed number of breast cancer cases in the age group 40-49 was higher than expected (P<0.001). The majority of patients (71%) were patients with infiltrating ductal carcinoma, 70% had advanced disease (Stage III), and in 51% of cases the tumour was more than 5 cm in size. Finally it was found that two-third of patients (76%) underwent modified radical mastectomy. Although this study does not address true incidence, but rather frequency, the findings suggest that the Iranian breast cancer patients are relatively younger than their western counterparts and mostly have locally advanced disease. In terms of breast cancer screening programs, these findings have some implications for public health professionals in Iran.