Clinical findings and follow-up evaluation of an outbreak of mushroom poisoning — survey of amanita phalloides poisoning

Amatoxins are one of the most potent toxins that cause hepatic and renal failure. However, this is the first report demonstrating an elevation of cardiac enzymes in a patient with Amanita phalloides poisoning. A 56-year-old male was admitted to the emergency department (ED) 42 h after an unknown type of mushroom ingestion. Hepatic, renal function tests, amylase and cardiac enzymes (troponin I, creatine kinase (CK), CK-MB isoenzyme and myoglobin) were found elevated in his blood chemistry. The electrocardiogram disclosed sinus tachycardia. Aggressive treatment with fluids, activated charcoal, penicillin G and silibinin were started. The patient was sent to hemodialysis because of anuria. During follow-up, biochemical parameters and clinical findings improved. The patient was discharged from the hospital following the arrangement of hemodialysis schedule because of the chronic renal failure. False elevations of cardiac markers may confuse the clinicians in differantial diagnosis of myocardial infarction in ED. In our patient, amatoxins that have bound the actin filaments within myocardiocytes or renal cells and/or its effects as circulating anti-troponin antibodies might result in elevation of cardiac markers. Elevated cardiac enzyme levels without any acute coronary syndrome are probable in mushroom poisoning cases involving amatoxin ingestion. Human & Experimental Toxicology (2007) 26, 757— 761

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Survey of Amanita phalloides poisoning: clinical findings and follow-up evaluation

Human & Experimental Toxicology ◽

10.1177/0960327107085832 ◽

2007 ◽

Vol 26 (12) ◽

pp. 955-961 ◽

Cited By ~ 20

Author(s):

M Křenová ◽

D Pelclová ◽

T Navrátil

Keyword(s):

Renal Damage ◽

Solitary Kidney ◽

Serum Levels ◽

Clinical Findings ◽

Amanita Phalloides ◽

Information Centre ◽

Prothrombin Index ◽

Student’S T ◽

Student’S T Test

The aim of our study was to evaluate the severity of hepatic and kidney damage with a focus on their reversibility, and to analyze the prognostic factors following Amanita phalloides poisoning based on calls made to the Czech Toxicological Information Centre. A variety of clinical and laboratory parameters were collected. Student’s t-test and Fisher’s test were used for statistical analysis. Amanita phalloides poisoning was verified in 34 cases (5 children, 29 adults). The following findings emerged: vomiting (76%), diarrhea (62%), hepatic failure (24%), and renal failure (11%). Two patients died on the fifth day after mushroom ingestion. In 18 patients, all serum levels normalized by the time of discharge; in 10 patients up to 7.3 months on average after discharge. Five patients did not comply with follow-up. Renal damage persisted in only one patient, 19 months after discharge. In conclusion, the interval to recovery from hepatic and renal damage by the time of discharge depended on a decrease in the prothrombin index and an increase in serum transaminase and bilirubin levels. Recovery was favorable in all subjects who survived the acute phase of poisoning, except in one patient with a solitary kidney.

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Improving diagnosis of acute appendicitis with atypical findings by Tc-99m HMPAO leukocyte scan

Nuklearmedizin ◽

10.1055/s-0038-1623994 ◽

2002 ◽

Vol 41 (01) ◽

pp. 37-41 ◽

Cited By ~ 3

Author(s):

S. Shung-Shung ◽

S. Yu-Chien ◽

Y. Mei-Due ◽

W. Hwei-Chung ◽

A. Kao

Keyword(s):

Acute Appendicitis ◽

False Positive ◽

False Positive Rate ◽

Accurate Method ◽

Clinical Findings ◽

Pathological Findings ◽

Lower Quadrant ◽

Predictive Values ◽

Positive Rate

Summary Aim: Even with careful observation, the overall false-positive rate of laparotomy remains 10-15% when acute appendicitis was suspected. Therefore, the clinical efficacy of Tc-99m HMPAO labeled leukocyte (TC-WBC) scan for the diagnosis of acute appendicitis in patients presenting with atypical clinical findings is assessed. Patients and Methods: Eighty patients presenting with acute abdominal pain and possible acute appendicitis but atypical findings were included in this study. After intravenous injection of TC-WBC, serial anterior abdominal/pelvic images at 30, 60, 120 and 240 min with 800k counts were obtained with a gamma camera. Any abnormal localization of radioactivity in the right lower quadrant of the abdomen, equal to or greater than bone marrow activity, was considered as a positive scan. Results: 36 out of 49 patients showing positive TC-WBC scans received appendectomy. They all proved to have positive pathological findings. Five positive TC-WBC were not related to acute appendicitis, because of other pathological lesions. Eight patients were not operated and clinical follow-up after one month revealed no acute abdominal condition. Three of 31 patients with negative TC-WBC scans received appendectomy. They also presented positive pathological findings. The remaining 28 patients did not receive operations and revealed no evidence of appendicitis after at least one month of follow-up. The overall sensitivity, specificity, accuracy, positive and negative predictive values for TC-WBC scan to diagnose acute appendicitis were 92, 78, 86, 82, and 90%, respectively. Conclusion: TC-WBC scan provides a rapid and highly accurate method for the diagnosis of acute appendicitis in patients with equivocal clinical examination. It proved useful in reducing the false-positive rate of laparotomy and shortens the time necessary for clinical observation.

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Follow-up of Osteomyelitis of Infants with Systemic Serum Parameters and Bone Scintigraphy

Nuklearmedizin ◽

10.1055/s-0038-1629824 ◽

1996 ◽

Vol 35 (04) ◽

pp. 116-121 ◽

Cited By ~ 4

Author(s):

G. E Fueger ◽

M. Vejda ◽

R. M. Aigner

Keyword(s):

Bone Scintigraphy ◽

Antibiotic Treatment ◽

Diagnostic Value ◽

Clinical Findings ◽

Laboratory Findings ◽

Radiographic Findings ◽

Serum Parameters ◽

Wbc Count ◽

Differential White Blood Cell

Summary Aim: To prevent orthopedic sequelae in acute hematogenous pyogenic osteomyelitis (AHPO) of infants early diagnosis, recognition of recurrence and effective therapy is needed. This retrospective study of 47 infants with bacteriologically confirmed AHPO concerned with an analysis of the diagnostic value of systemic serum parameters compared to bone scintigraphy (BSC). Methods: AHPO was characterized initially and during the course of disease by clinical findings, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total and differential white blood cell (WBC) count, BSC, and plain radiography. Results: CRP was the most effective serum parameter for follow- up of disease. The first sign of BSC to signal adequate response to antibiotic treatment was the decrease or normalization of hyperperfusion. Escape from therapy or poor prognosis, even when the serum parameters were normalized, was signaled by the recurrence of focal hyperperfusion and the persistent or increasing local uptake ratios on the 3-h-image over 6 weeks during a course of antibiotic treatment. Conclusion: Antibiotic treatment masks the clinical presentation, and the radiographic findings, causes non-characteristic laboratory findings, but do not prevent the scintigraphic visualization; BSC and serum parameters used in the right completion are the most successful and efficient modalities for follow-up of AHPO. Maintenance of antibiotic therapy should be done until BSC findings have reverted to normal.

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Obesity management through Ayurveda - A Case Study

Journal of Ayurveda and Integrated Medical Sciences (JAIMS) ◽

10.21760/jaims.v2i4.9377 ◽

2017 ◽

Vol 2 (4) ◽

Author(s):

Dheeraj Kumar Tyagi ◽

Shivakumar .

Keyword(s):

Clinical Findings ◽

Dietary Habit ◽

Unhealthy Lifestyle ◽

Lifestyle Management ◽

Before And After ◽

Effect Of Treatment ◽

And Control

Lifestyle disorders are one of the biggest threats for the population living unhealthy lifestyle. Sthoulya (Obesity) is one such disorder which creates lot of physical as well as mental disorder to the sufferer. Due to changing lifestyle, comforts and dietary habit lots of individuals changed their life totally. Obesity is a growing disease in developed and developing countries. Prevalence is drastically hike in past few years. Ayurveda, the science of life with which we can manage and control lots of lifestyle disorders. Focusing on dietary and lifestyle management along with treatment, we can overcome the hazards of obesity which is growing in a uncontrolled manner. The available data is based on the clinical findings only. Aim and objective: To assess the effect of “Guru Cha Atarpanam Chikitsa” in the management of Sthoulya. Setting: Swastharakshana evam Yoga, OPD and IPD, SDMCAH, Hassan. Method: Udwarthana, Parisheka, Shamana Aushadhis, Ahara, and Vihara was followed within the treatment duration and effect of treatment was assessed before and after treatment, advised for follow up. Results: The treatment adopted is effective in the management of Sthoulya and to improve the quality of life.

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Endoscopy-assisted removal of periorbital inclusion cysts in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.11.peds10332 ◽

2011 ◽

Vol 7 (2) ◽

pp. 161-164 ◽

Cited By ~ 5

Author(s):

George Chater-Cure ◽

Caitlin Hoffman ◽

Jared Knopman ◽

Samuel Rhee ◽

Mark M. Souweidane

Keyword(s):

High Speed ◽

Complete Removal ◽

Skin Incision ◽

Clinical Findings ◽

Complete Excision ◽

Alternative Approach ◽

Cyst Recurrence ◽

Scalp Incision ◽

Access Technique

Object Surgical treatment for periorbital inclusion cysts typically involves a brow, pterional, or partial bicoronal scalp incision for sufficient exposure. The authors have recently employed an endoscopy-assisted technique as an alternative approach intended to minimize the length of the skin incision and avoid scarring in the brow. Methods Children having typical clinical findings of a dermoid cyst located on the hairless forehead were selected to undergo endoscopy-assisted cyst removal. For suspected intradiploic lesions, MR imaging was used to assess osseous involvement. After induction of general anesthesia, a 1–2-cm curvilinear incision was made posterior to the hairline. A 30°-angled endoscope (4 mm) was then used for dissection in the subgaleal compartment. Subgaleal dissection was followed by a circumferential periosteal incision in which the authors used an angled needle-tip unipolar cautery. For lesions within the diploe, a high-speed air drill was used to expose the lesion. Complete removal was accomplished with curettage of either the skull or dural surface. Results Eight patients (5–33 months of age) underwent outpatient endoscopic resection. Seven cysts were extracranial, and 1 cyst extended through the inner table. In all patients complete excision of the cyst was achieved. There was negligible blood loss, no dural violation, and no postoperative infection. There have been no recurrences at a mean follow-up of 15 months. Conclusions Endoscopy-assisted resection of inclusion cysts of the scalp and calvaria is a safe and effective surgical approach. The technique results in negligible incisions with less apparent scarring compared with previously described incisions. This limited-access technique does not appear to be associated with a higher incidence of cyst recurrence.

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Corneal cross-linking for treatment of progressive keratoconus in a patient with Alport syndrome: A case report

European Journal of Ophthalmology ◽

10.1177/1120672121997672 ◽

2021 ◽

pp. 112067212199767

Author(s):

Iva Krolo ◽

Aida Kasumović ◽

Ivana Radman ◽

Pavao Pavić

Keyword(s):

Case Report ◽

Alport Syndrome ◽

Contact Lenses ◽

Corneal Dystrophy ◽

Clinical Findings ◽

Cross Linking ◽

Posterior Polymorphous Corneal Dystrophy ◽

One Year ◽

Corneal Tomography

Purpose: Ocular features of Alport syndrome include anterior lenticonus, posterior polymorphous corneal dystrophy, and fleck-and-dot retinopathy in most cases. Keratoconus in such patients has been rarely mentioned in previous studies. To our knowledge, this is the first report of corneal cross-linking for halting the progression of keratoconus in a patient with Alport syndrome. Case report: A 22-year-old male was referred for his initial corneal topography, after he was already prescribed with rigid gas-permeable contact lenses. Alport syndrome was diagnosed in his infancy and gene COL4A5 mutation was confirmed. Ophthalmological evaluation confirmed keratoconus. One-year follow-up showed a progression on his right eye and standard corneal cross-linking was performed. Stabilization of the disease marked by normalization in visual function and corneal tomography values was noticed 1 year after the procedure. Conclusions: When diagnosing ocular clinical findings of Alport syndrome, keratoconus should be considered. Standard corneal cross-linking protocol can halt its progression.

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Acute Liver Failure Caused byAmanita phalloidesPoisoning

International Journal of Hepatology ◽

10.1155/2012/487480 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 45

Author(s):

Luca Santi ◽

Caterina Maggioli ◽

Marianna Mastroroberto ◽

Manuel Tufoni ◽

Lucia Napoli ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Failure ◽

Acute Liver Failure ◽

Rna Polymerase Ii ◽

Gastrointestinal Symptoms ◽

Amanita Phalloides ◽

Prognostic Indicators ◽

Mushroom Poisoning ◽

Lag Phase ◽

Kidney Involvement

Mushroom poisoning is a relatively rare cause of acute liver failure (ALF). The present paper analyzes the pathogenesis, clinical features, prognostic indicators, and therapeutic strategies of ALF secondary to ingestion ofAmanita phalloides, which represents the most common and deadly cause of mushroom poisoning. Liver damage fromAmanita phalloidesis related to the amanitins, powerful toxins that inhibit RNA polymerase II resulting in a deficient protein synthesis and cell necrosis. After an asymptomatic lag phase, the clinical picture is characterized by gastrointestinal symptoms, followed by the liver and kidney involvement. Amatoxin poisoning may progress into ALF and eventually death if liver transplantation is not performed. The mortality rate afterAmanita phalloidespoisoning ranges from 10 to 20%. The management of amatoxin poisoning consists of preliminary medical care, supportive measures, detoxification therapies, and orthotopic liver transplantation. The clinical efficacy of any modality of treatment is difficult to demonstrate since randomized, controlled clinical trials have not been reported. The use of extracorporeal liver assist devices as well as auxiliary liver transplantation may represent additional therapeutic options.

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Foot-to-Shoe Mismatch and Rates of Referral in Special Olympics Athletes

Journal of the American Podiatric Medical Association ◽

10.7547/1020187 ◽

2012 ◽

Vol 102 (3) ◽

pp. 187-197 ◽

Cited By ~ 5

Author(s):

David W. Jenkins ◽

Kimbal Cooper ◽

Rachel O’Connor ◽

Liane Watanabe

Keyword(s):

Power Analysis ◽

Clinical Findings ◽

Special Olympics ◽

Future Studies ◽

Foot Structure ◽

Ultimate Outcome ◽

And Performance

Background: Improperly fitted shoes are frequently seen in athletes participating in Special Olympics competitions. This foot-to-shoe mismatch may result in deformities as well as discomfort and reduced performance or injuries in competitions. A primary purpose for providing medical screenings is to identify conditions unknown and to promptly refer to an appropriate provider for evaluation and care. This study attempts to determine the prevalence of improperly fitted shoes and the rate of referral for Special Olympics athletes screened at Fit Feet venues. Methods: To evaluate the foot-to-shoe mismatch and rate of referral, 4,094 Fit Feet screenings of Special Olympics athletes participating in US competitions in 2005 to 2009 were analyzed. The participants were 58.5% male and 41.5% female, with a median age of 25.6 years. A power analysis and the χ2 test were used. The athletes voluntarily underwent a foot screening that followed the standardized Special Olympics Fit Feet protocol. The Brannock Device for measuring feet was used to assess proper fit. Results: A proper fit was found in 58.56% of the athletes, with 28.60% wearing shoes too big and 12.84% wearing shoes too small. Unrelated to shoe fit, 20% of the athletes required referrals for professional follow-up based on abnormal clinical findings. Conclusions: There is a significant (41.44%) mismatch of foot to shoe in Special Olympics athletes. The most common mismatch is a shoe too big, with a much smaller number of athletes having shoes too small. Awareness of this foot-to-shoe incompatibility may be useful for the development of shoes better designed for athletes with a foot structure not consistent with conventional shoes. Because 20% of the athletes required a referral for professional follow-up, Fit Feet examinations are important for identifying athletes with conditions that can be more readily evaluated and treated, thus improving the athletes’ comfort and performance. Beyond knowing the rate of referral, future studies can determine the conditions or findings that necessitate a referral and the ultimate outcome of that referral. (J Am Podiatr Med Assoc 102(3): 187–197, 2012)

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Thoracolumbar Fascia Enthesopathy as a Cause of Low Back Pain: A Retrospective and Follow-up Study

10.21203/rs.3.rs-219002/v1 ◽

2021 ◽

Author(s):

Ouidade A. Tabesh ◽

Roba Ghossan ◽

Soha H Zebouni ◽

Rafic Faddoul ◽

Michel Revel ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Iliac Crest ◽

Pain Syndrome ◽

Clinical Findings ◽

Complete Relief ◽

Low Back ◽

Thoracolumbar Fascia ◽

The Mean

Abstract Aim. To evaluate ultrasonography findings of Thoracolumbar Fascia (TLF) enthesis in patients with low back pain (LBP) due to iliac crest pain syndrome (ICPS). Method. The ultrasonographic and clinical findings of 60 patients with LBP due to ICPS were compared to those of 30 healthy volunteers with no LBP. Thickness of the TLF was measured with ultrasound (US) at its insertion on the iliac crest. Results. Forty-eight women and 12 men with a mean age of 42.1±11.3 years were diagnosed with ICPS. In patients, the mean thickness of the TLF was 2.51±0.70mm in affected sides compared to 1.81±0.44mm in the contralateral unaffected sides. The mean thickness difference of 0.82mm between the affected and non-affected sides was statistically significant (95%CI, 0.64-0.99, P<0.0001). In volunteers, the mean thickness of the TLF was 1.6±0.2mm. The mean thickness difference of 0.89mm between the affected sides of patients and volunteers was statistically significant (95%CI, 0.73-1.06, P<0.0001). Forty-two patients who didn’t improve with conservative therapy, received injections of methylprednisolone acetate and 1% lidocaine around the TLF enthesis. All patients reported complete relief of their LBP within 20 minutes of the injections thanks to the lidocaine anesthetic effect. Fifty-six (93.3%) patients were reached by phone for a long-term follow-up. Among them, 33 (58.9%) patients experienced a sustained complete pain relief after a mean follow-up of 45±19.3 months (range, 3-74 months). Conclusion. our findings suggest that TLF enthesopathy is a potential cause of nonspecific LBP that can be diagnosed using US.

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