Self-poisoning in Newcastle, 1987-1992

OBJECTIVE

To examine the morbidity and mortality associated with self-poisoning with different drug classes.

DESIGN

Prospective cohort study with limited follow-up. Retrospective analysis of coronial data.

SETTING

Primary and tertiary referral toxicology centre covering Newcastle and Lake Macquarie, Australia, 1987-1992.

RESULTS

There were 1969 admissions after ingestion of 3724 substances (2424 prescription drugs and 1300 non-prescription items). The coroner investigated 83 drug-related deaths. Only 12 of these people presented to hospital and, for most of these, death was inevitable at presentation. The most frequently ingested substances were benzodiazepines, alcohol, paracetamol, antidepressants, neuroleptics and anticonvulsants. Since 1980, the percentage of self-poisonings involving benzodiazepines has fallen, while it has risen for those involving antidepressants. Over 50% of deaths were due to tricyclic antidepressants or opioid analgesics.

CONCLUSIONS

As death usually occurs out of hospital, interventions to decrease mortality from self-poisoning must focus on prevention, and targeting drugs that are frequently taken or frequently lethal in overdose. Consideration should be given to the use of antidepressants that are safer in overdose. The use of antidepressants, barbiturates or chloral hydrate as sedatives should be discouraged.

Correlations between prescriptions and drugs taken in self-poisoning. Implications for prescribers and drug regulation

OBJECTIVE

To compare prescription data for Australia with drugs ingested in self-poisoning and suicide, to determine which drugs are over-represented.

DESIGN

Comparison of data on drugs taken in self-poisoning admissions and suicides with Australian prescription drug dispensing data from the Drug Utilization SubCommittee (DUSC).

SETTING

Newcastle and Lake Macquarie, Australia, 1989-1992.

SUBJECTS

Between July 1989 and June 1992, 1159 prescription drugs were taken in overdose. Eighty-three drug-related deaths were investigated by the coroner between 1987 and 1992. On 48 occasions a prescription drug was the primary cause of death.

RESULTS

Drugs over-represented in self-poisoning (relative to Australian prescriptions) included not only those prescribed for psychiatric conditions (antidepressants, neuroleptics and lithium), but also benzodiazepines, barbiturates and other anticonvulsants. The highest odds ratios for death when adjusted for prescription numbers were for short-acting barbiturates (523.7; 95% confidence interval [CI], 207-1322), chloral hydrate (58.1; 95% CI, 18.1-187), colchicine (27.9; 95% CI, 3.8-202), dextropropoxyphene (20.8; 95% CI, 8.8-48.9), tricyclic antidepressants (13.3; 95% CI, 7.2-24.5) and anticonvulsants (11.6; 95% CI, 4.1-32.2).

CONCLUSIONS

Short-acting barbiturates, chloral hydrate and dextropropoxyphene have little or no clinical advantage over alternatives and excessive toxicity in overdose. They should be removed from the market. The toxicity of anticonvulsants and colchicine should be considered when they are prescribed, and smaller amounts per prescription may be advisable for high risk patients using these and other toxic drugs.

A human colon cancer cell line established from collagen matrix cultures transplanted into nude mice

A new human colon cancer cell line (020588) has been derived by means of a combined in vitro matrix-in vivo xenograft technique. The tumour cell line is carcino-embryonic antigen positive, displays a marker chromosome and proliferates in chemically-defined serum-free culture medium. The chemosensitivity pattern for the tumour cell line was similar to that observed for the parent tumour cells. The novel method used to establish this continuous human tumour cell line may have several advantages over standard techniques.

Xanthogranulomatous pyelonephritis in a renal allograft: a case report

We report a case of xanthogranulomatous pyelonephritis in a renal allograft. The kidney was not removed and there was an initial response to antibiotic therapy, with amelioration of toxicity and improvement in renal function. However, the kidney failed 10 months later in association with histological changes of chronic rejection.

Renal pelvic carcinoma in the Hunter Valley

In the Hunter Valley, New South Wales, the incidence of renal pelvic carcinoma was found to be very high, and there appeared to be a causal relationship with analgesic abuse. The crude incidence rate was calculated at 1.6/100000 population per year. In half of the cases of renal pelvic carcinoma, there was evidence of analgesic abuse and/or analgesic nephropathy with papillary necrosis; in this group the male/female ratio was 1/2.6, and there was a tendency for the cancers to occur at a younger age. Tumours associated with analgesic nephropathy were more often poorly differentiated and in a more advanced stage at the time of diagnosis than those not associated with analgesic nephropathy. Multiple tumours were equally common in both groups, but coexistent flat carcinoma in situ tended to be more common in cases associated with analgesic nephropathy.