Atropine poisoning in children during the Persian Gulf crisis. A national survey in Israel

OBJECTIVE

To evaluate the effects of high doses of atropine in children accidentally injected with automatic atropine injectors. These were distributed in Israel during the Persian Gulf Crisis as an antidote for chemical warfare agents.

DESIGN AND SETTING

A national survey in pediatric emergency departments in Israel, involving 22 medical centers, with prospective data collection in 14 centers.

PATIENTS

Children (n = 268) presenting to emergency departments following misuse of automatic atropine injectors.

MAIN OUTCOME MEASURES

Documentation of atropine dose and clinical manifestations; determination of a clinical severity score and its correlation with atropine dose; measurements of serum atropine levels in six patients.

RESULTS

Over a period of 4 months, 268 cases were reported, of which 240 were clinically evaluated. The most common site of injection (75%) was the finger or palm. Doses were up to 17-fold higher than standard doses for age. In 116 children (48%), systemic effects of atropine were observed, and 20 (8%) had severe atropinization. Seizures and life-threatening arrhythmias were not reported, and there were no fatalities. The severity of atropinization was correlated with the dose following a classic nonlinear, dose-response relationship. Serum atropine levels (6.2 to 61.0 ng/mL) were much higher than those observed after administration of therapeutic doses.

CONCLUSIONS

The high incidence of injection in the hand implies accidental use of automatic atropine injectors among children. The lack of mortality or life-threatening complications from injection of large doses of atropine attests to its relative safety in children. The low risk from atropine injections weighed against expected benefit as a lifesaving antidote justifies the distribution of personal atropine injectors to children at risk of organophosphorus nerve agent attack.

Prenatal diagnosis of tetralogy of Fallot with absence of the leaflets of the pulmonic valve

Tetralogy of Fallot with absence of the leaflets of the pulmonic valve is relatively rare. We describe the prenatal diagnosis of this malformation in two fetuses. The association between the agenesis of the arterial duct and absence of the valvar leaflets is discussed. The diagnosis of the syndrome in the presence of dilated and pulsatile pulmonic arteries is easy to make. It should allow early counselling and planning of early care after delivery.

Cyclophosphamide, doxorubicin, dexamethasone and procarbazine: effect on seminal plasma sialyltransferase activity

The influence of chemotherapy agents, doxorubicin (adriamycin), cyclophosphamide, procarbazine, and dexamethasone on the activity of sialyltransferase in human semen has been examined. Aliquots of 25 mcL semen were incubated for 2 hours with the above substances at concentrations ranging from 10 to 800 mcg/incubation mixture. The measurement of sialyltransferase activity was based on the incorporation of radioactive sialic acid from CMP (14) C sialic acid) into asialofetuin. Doxorubicin and cyclophosphamide, at the maximal concentration of 800 mcg/incubation mixture exhibited an inhibiting effect on sialyltransferase activity which accounted for 15.7 +or- 16% and 12.2 +or- 16%, respectively. The rate of inhibition following incubation with maximal doses of dexamethasone (400 mcg) was 25.3 +or- 13%, respectively. The rate of inhibition following incubation with maximal doses of dexamethasone (400 mcg) was 25.3 +or- 12%. Inhibition caused by procarbazine did not exceed 5%. Inhibition of sialyltransferase in human semen by the materials examined in this study can diminish the transfer of sialic acid, thus interfering with normal glycoprotein's and glycolipid's syntheses in semen and possibly also in other fluids and tissues.

Some characteristics of azoospermic human semen

Of 260 volume measurements and 265 fructose determinations on 257 azoospermic semen samples, the volume was normal (1-6 mL) in 78%, low in 16.7%, and high in 5.2%. The percentage of azoospermic samples with low volume was greater than that found for samples containing sperm. Mean fructose concentrations were similar in high-volume and normovolemic azoospermic samples, but significantly lower in low-volume samples. There was no correlation between (a) the etiology of the azoospermia and abnormal semen volume or fructose concentration (save for cases of obstruction and/or atrophic seminal vesicles) or (b) semen volume, fructose concentration, and serum LH, FSH, testosterone, or prolactin.

Nontraumatic, acute neonatal paraplegia

Nontraumatic, acute neonatal paraplegia with associated lower limb vascular phenomena is a relatively rare condition. Three such cases are reported. The paralysis is primarily motor with minimal neurologic recovery. Contractures and bizarre deformities develop at an early stage and necessitate repeated orthopaedic intervention. The most likely etiology appears to be a vascular insult to the spinal cord.

Self report and performance-based hand function tests as correlates of dependency in the elderly

Preventing or minimizing functional dependency in older adults rests, in part, upon the ability to predict who is at risk. The purpose of this study was to compare the ability of five tests of hand function to discriminate the degree of dependency in older adults. Seven hundred sixty four subjects were assessed for hand function on performance-based (Williams Test of Hand Function, a test of Williams Board items only, Jebsen Test of Hand Function, grip strength), and self-reported (Dexterity Scale of the Geriatrics-Arthritis Impact Measurement Scale (GERI-AIMS] measures of hand function, and self-reported multidimensional functional status (GERI-AIMS). A trichotomous variable representing a continuum of dependency based upon living site (independent living, home-bound, institutional) was used as the measure of dependency. Sixty-two cases were dropped for incomplete data. Discriminant function analyses of the 702 subjects (age X = 76.78 years, SD = 8.79) showed that basic demographic variables explain 40.8% of the variance in dependency; all hand function tests significantly correlated with dependency; the Williams Board correlated best (additional 12.5% variance explained). However, a multidimensional functional status measure explains substantially more variance in dependency (16.9%) after controlling for demographic variables and performance on the Williams Board. This comparison of methods and tests available for measuring hand function was made to provide criteria for selecting an instrument for a given setting.

Intravenous immunoglobulin for Flavobacterium-induced thrombocytopenia in a premature infant

Gram-negative septicemia at times causes morbidity and mortality in newborn nurseries. Prophylactic intravenous immunoglobulin results in a significant decrease in incidence and severity of septicemia resulting from infection in infants. The present case report describes the successful use of high-dose intravenous immunoglobulin in a Flavobacterium-induced thrombocytopenia in a premature infant.

Inhibition of sialyl transferase activity by gossypol acetic acid in human seminal plasma

Seventeen aliquots of 15 microliters seminal plasma of human origin were incubated with 25 micrograms, 15 micrograms, 5 micrograms and 2.5 micrograms gossypol acetic acid (GAA), dissolved in BWW containing 0.9% sodium chloride and 0.9% benzyl alcohol, at 37 degrees C for 60 minutes. Following incubation, activity of sialyl transferase (S.T.) was determined by a procedure involving incorporation of radioactive sialic acid into asialofetuin. The activity of S.T., expressed as cpm per hour per 15 microliters seminal plasma was compared to controls consisting in incubation of sperm in BWW containing 0.9% benzyl alcohol and 0.9% sodium chloride. The activity of S.T. in controls represented 61.3 +/- 8.0%-67.7 +/- 8.9% of the activity obtained by incubation with BWW only. GAA was found to exert a dose-dependent inhibition of S.T. activity, ranging from 38.3 +/- 20.6% to 53.4 +/- 19.4% (with 25 micrograms) and from 11.3 +/- 14.8% to 21.9 +/- 14.8% (with 2.5 micrograms).

Low energy narrow band non-coherent infrared illumination of human semen and isolated sperm

Sixty-two samples of human normal and abnormal semen and 23 samples of washed sperm were illuminated for 4 minutes with a narrow band non-coherent infrared device (BioBeam). Immediately after illumination the following parameters were examined in comparison with appropriate controls: motility, viability and morphology, fructose content of semen, acrosome reaction of sperm, viscosity of seminal plasma and analysis of the protein pattern. The mean value of motility grade calculated for the total number of 62 semen samples was 2.58 +/- 0.79 versus 2.17 +/- 0.75 (non illuminated controls), P less than 0.005. The mean value of motility grade of 23 samples of washed sperm was 2.89 +/- 0.77 versus 2.43 +/- 0.62, respectively (P less than 0.01). In two illuminated seminal plasma specimens, the viscosity was decreased by 8.8% and 14.8%, the protein content and pattern remained, however, unchanged. Neither the percentages of motile, viable and morphologically normal sperm, nor the fructose content of semen were found to be affected by the illumination.

Semen volume and fructose content of human semen. Survey of the years 1980-1989

The communication presents percentages of semen with low (less than 1 ml) and high (greater than or equal to 6 ml) volume and of semen with decreased fructose content (less than 1 ml) in the total number of 8,128 human specimens analyzed during the years 1980-1989. Percentages of low volume specimens and of specimens with decreased fructose content were found to increase with time. High volume semen lacked such trend.

Upper Eocene Gilled Mushroom from the Dominican Republic

Coprinites dominicana gen.nov., spec.nov. (Coprinaceae) found in amber from the Dominican Republic is the earliest known gilled mushroom, the first fossil fleshy agaric determinable, and the only kiiown fossil "mushroom" (Agaricales) from the tropics. This find is of significance with respect to the evolutionary development of the Basidiomycetes. Because the appearance of this fossil is quite modern, it suggests that mushrooms as a group probably arose much earlier than the early to mid-Tertiary.

Separation of sub-populations of sperm with higher fertility potential from normal and pathological semen by peanut agglutinin

Incubation of human sperm from semen with counts below 20 x 10(6)/ml with peanut agglutinin (PNA) resulted in agglutination of about 70% of sperm. An inverse correlation was found between non-agglutinating (PNA) sperm and sperm density (r = 0.48, p less than 0.01) and a direct correlation with acrosome-damaged sperm (r = 0.83, p less than 0.001). Binding of 125I-PNA to sperm revealed high, and possibly also low affinity binding sites on sperm from both normozoospermic and oligozoospermic origins. Quantitative transmission electron microscopy analysis revealed that agglutinated, PNA+, sperm had lower frequency of acrosomeless spermatozoa than PNA(-)-sperm (44% versus 77%) and higher fertility score (+0.18 +/- 0.1 and -1.5 +/- 0.87 respectively, p less than 0.01). Removal of PNA- sperm from oligozoospermic semen may increase the fertility score of the remaining sperm.

Andrological parameters in men with high sperm counts and possible correlation with age

Two hundred eighty six human semen samples with sperm counts above 200 million/ml, were divided into 3 groups according to semen volume: (1) less than 1 ml (low), (2) 1 ml-5 ml (normal), and (3) greater than or equal to 6 ml (high). Each group was examined for routine andrological parameters. Also examined was a possible correlation between sperm counts, semen volumes, and ages of patients. The quality of motility (percent and grade) and viability of sperm were generally lowest in specimens with a volume below 1 ml and highest in those of normal volume. Proportions of morphological normality exhibited a similar trend, lacking, however, statistical significance. The mean fructose content of low-volume semen was significantly decreased in comparison with those of normal volume. Patients with low-volume semen and sperm counts above 200 million/ml were older than those with similar sperm counts and normal volume. The mean ages of all patients with high sperm counts of semen were higher than of those with lower sperm counts. It was assumed that in contradiction to specimens with high sperm counts and low volume, those whose volumes range from 1 ml-5 ml should be considered normal with respect to motility, viability, and morphological normality.

The safety and tolerability of quinapril

Quinapril, a new angiotensin-converting enzyme (ACE) inhibitor with an intermediate duration of action, has been extensively studied in patients with hypertension and congestive heart failure (CHF) during a worldwide clinical development program. A comprehensive safety data base was established to allow appropriate analyses of the extensive patient safety data. The safety of quinapril has been evaluated in 2,697 patients with hypertension and CHF, including 451 elderly patients (greater than or equal to 65 years), and has been compared with safety data from a total of 1,058 patients receiving a comparative therapy. A comparison of the double-blind studies demonstrated that quinapril has a lower incidence of adverse events and/or withdrawals than reported for captopril or enalapril. An analysis of the onset of adverse events did not show either an increase with time on quinapril therapy or a dose relationship. The proportion of patients who experienced orthostatic hypotension or hypotension was less than that of patients who were treated with captopril or enalapril. An analysis of all events (from both double-blind and long-term, open-label studies) showed no increase in the incidence of events reported in patients with CHF compared with hypertensive patients. When the data for all studies were combined, an age analysis showed no increase in the total reporting of adverse events in elderly patients compared with the younger patients studied. The incidence of adverse events was lower in those patients not receiving concomitant diuretic therapy. An overall analysis of clinical laboratory data indicated that quinapril did not have significant adverse effects on clinical laboratory parameters when compared with captopril, enalapril, or placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunosuppressive activity and polyamine levels of seminal plasma in azo-ospermic, oligospermic, and normospermic men

Seventy specimens of human seminal plasma obtained from azo-ospermic, oligospermic, and normospermic men were tested for immunosuppressive activity on normal donor lymphocytes. Spermine and spermidine levels in acidic extracts were determined in 32 specimens of seminal plasma from the three groups. The original seminal plasma as well as the neutralized spermine extracts were examined for their effect on the functional activity of the lymphocytes. Seminal plasma obtained from the normospermic and oligospermic semen showed significant immunosuppressive activity, whereas no immunosuppressive activity was induced by seminal plasma from azo-ospermic semen. The latter finding was in accordance with the low spermine levels in azo-ospermic semen, which were about 50% of those found in normospermic and oligospermic seman. Acidic extraction of the seminal plasma of azo-ospermic origin resulted in an increase in spermine levels and also in immunosuppressive activity, demonstrating that in azo-ospermic men spermine is bound probably to a protein and is released after acidification, exerting its immunosuppressive activity only when unbound.

Andrological parameters in human semen of high (greater than or equal to 6 ml) and low (less than or equal to 1 ml) volume

A study was carried out to evaluate 792 semen of high (greater than or equal to 6 ml) and low (less than or equal to 1 ml) volume and sperm counts ranging from 0.1 to 200 x 10(6) per ml. Particularly emphasized were: motility percentage and grade, percentage viability, morphologically normal sperm and immature cells, and the concentration of fructose in semen (mg/ml). The Duncan multiple range test and the Kruskal-Wallis test with multiple comparison of ranks were used in the statistical analyses. The results show that abnormal semen volume influence neither the basic tendency of andrological parameters to change in accordance with sperm counts of semen nor to correlate with each other. The quality of motility was significantly higher in specimens of high semen volume as compared to those of low semen volume. The concentration of fructose in semen was generally higher in specimens of high volumes than in those of low volumes, including semen devoid of sperm. It was assumed that in general increased semen volume does not affect the quality of other andrological parameters, thus being probably unrelated with fertility potential. The considerably lower values of both motility and viability characterizing the semen of low volume would suggest a lower fertility potential of specimens affected by this type of abnormality.

The influence of seminal plasma and polyaminic substances on the motility of isolated human sperm

The purpose of the study was to examine the influence on the motility patterns of isolated human sperm of seminal plasma originating from semen of high and low motility, as well as of seminal plasma of azoospermic origin. Also assessed was the effect of incubation of sperm in the presence of solutions of the polyamines spermine, spermidine, and putrescine. The mean values of the obtained motility percentage and grade were related to the quality of sperm motility in semen and the quality of seminal plasma in that respect. The best results were obtained with specimens containing greater than or equal to 50% motile sperm and having a motility grade greater than or equal to 2. No relationship was found between the concentrations of polyamines in the seminal plasma and sperm motility of respective semen, as well as between the levels of polyamines and their effect on isolated sperm motility. It appears that the participation of polyaminic substances in the process of motility could be contributive and dependent on additional factors present in the semen.

Beta-endorphin and calcitonin in human semen

The levels of beta-endorphin (beta-E) and calcitonin were estimated in 36 samples of seminal plasma from semen of normospermic, oligozoospermic, and azoospermic origins and in pools of isolated sperm. The mean levels in plasma calculated for all samples examined were 192 +/- 224 pg/ml for beta-E and 754 +/- 397 pg/ml for calcitonin. The amounts in sperm were as follows: for beta-E in pools with sperm counts of 0.1-10 x 10(6)/ml, 157.2 +/- 99.7 pg/10(8) and 27.9 +/- 23.6 pg/ml protein; in pools of greater than 10-30 x 10(6)/ml, 71.2 +/- 41.5 pg/10(8) and 6.5 +/- 1.2 pg/mg protein; in pools of greater than 30-200 x 10(6)/ml, 24.9 +/- 9.7 pg/10(8) and 61 +/- 1.9 pg/mg protein. For calcitonin the amounts were: 501.2 +/- 170.8 pg/10(8) and 27.4 +/- 21.5 pg/mg protein, correspondingly. It was suggested that beta-E and calcitonin present in seminal plasma are synthesized mostly in a compartment of the male reproductive system. The high cellular beta-E and calcitonin levels would be involved in the process of motility through their effect on calcium transport.