Colchicine poisoning by accidental ingestion of meadow saffron (Colchicum autumnale): pathological and medicolegal aspects

Although intoxications with colchicine, the alkaloid of Colchicum autumnale (meadow saffron), are well known, in most cases the intoxications are evoked by oral or parenteral preparations traditionally used as medication against gout. The accidental ingestion of Colchicum autumnale, on the other hand, is a rare event and has to our knowledge only twice been described in detail. We report a further case in which two persons confused this highly poisonous plant with wild garlic (Allium ursinum), a popular spice in the Central European cuisine. While one person merely complained about a 3-day episode of nausea, vomiting and watery diarrhea, the second person died of multi-organ system derangements 48 h after the ingestion of the colchicum leaves. At autopsy hemorrhagic lung oedema, hypocellular bonemarrow, centrilobular fatty necrosis of the liver and necrosis of the proximal convoluted tubuli of the kidneys were observed. A colchicine concentration of 7.5 micrograms/ml was found in the bile whereas no substance was detected in the postmortem blood.

Tissue implantation test in rabbits with gelatine sponges

The purpose of this implantation study was to evaluate possible toxic effects and quality and quantity of resorption of two different resorbable gelatine sponges when implanted into the paravertebral muscle of the rabbit for a period of 7, 14 or 21 days and to evaluate bioequivalence of two types of test material. Test materials (Gelaspon) and a commercially available reference material were compared in three groups with 6 rabbits each. Tissue reaction to the implants and sponge degradation were scored on a graded scale and the sponges were compared for evaluation. No treatment-related mortality or body weight changes were observed. Clinical signs, indicative of local effects, were mainly seen for reference material. Tissue reaction after 7 days was comparable, after 14 and 21 days a significant increase in granulomatous reaction was seen for reference material. Sponge degradation was complete for test materials after 14 and 21 days without inflammatory tissue reaction, but small sponge rests of reference material were still present, accompanied by an increased inflammatory response. Results show test materials to fulfil the clinical requirements for implant material concerning fast resorption without inflammatory reactions and its superiority to reference material. Bioequivalence of used types of test material could be confirmed.

Antiapoptotic activity of the herpesvirus saimiri-encoded Bcl-2 homolog: stabilization of mitochondria and inhibition of caspase-3-like activity

Viruses have evolved different strategies to interfere with host cell apoptosis. Herpesvirus saimiri (HVS) and other lymphotropic herpesviruses code for proteins that are homologous to the cellular antiapoptotic Bcl-2. In this study HVS-Bcl-2 was stably expressed in the human leukemia cell line Jurkat and in the murine T-cell hybridoma DO to assess its antiapoptotic spectrum and to gain further insight into its mode of action. HVS- Bcl-2 prevented apoptosis that occurs as a result of a disturbance of intracellular homeostasis by, for example, DNA damage or menadione, which gives rise to oxygen radicals. In Jurkat cells, HVS-Bcl-2 also inhibited apoptosis mediated by the death receptor CD95. In DO cells, HVS-Bcl-2 did not interfere with CD95-mediated apoptosis but blocked dexamethasone-induced cell death. Mitochondrial damage is a central coordinating event in apoptosis induced by different stimuli. To assess the integrity of mitochondria, we used rhodamine 123, which is released upon disturbance of the mitochondrial membrane potential, and determined the release of cytochrome c into the cytosol. Both signs of mitochondrial damage were prevented by HVS-Bcl-2. This viral protein also inhibited the generation of caspase-3-like DEVDase activity and blocked the cleavage of poly(ADP-ribose) polymerase, a natural substrate of caspase-3-like proteases. In conclusion, HVS-Bcl-2 protects against a great variety of apoptotic stimuli, stabilizes mitochondria, and acts upstream of the generation of caspase-3-like activity.

The implementation of a quality-net as a part of the European project DIABCARE Q-Net

DIABCARE Q-Net is a European project with a consortium of partners in healthcare, industry, and research, which has the overall target of improvement in diabetes care by aggregation, evaluation, and feedback of anonymized patient data with the tools of modern telematics, resulting from the initiative of the St. Vincent-Declaration, St. Vincent, Italy. Based on standardized tools for quality improvement in diabetes care, i.e., the Basic Information Sheet (BIS) and recently developed data entry and feedback software (DIABCARE Data for Windows), DIABCARE Q-Net as a part of the Telematics Applications Program of the European Commission will improve diabetes care and disease management by the implementation of a quality network. Therefore, the project implements regional, national, and central nodes for processing of diabetes quality indicators. All participating centers (GP's and clinics in Europe) get feedback by standardized benchmarking. The pilot testing and the state of implementation of our network confirm the importance of improving the quality of life of diabetic patients in all participating countries.

Herpesvirus saimiri transforms human T-cell clones to stable growth without inducing resistance to apoptosis

Herpesvirus saimiri (HVS) transforms human T cells to stable growth in vitro. Since HVS codes for two different antiapoptotic proteins, growth transformation by HVS might be expected to confer resistance to apoptosis. We found that the expression of both viral antiapoptotic genes was restricted to cultures with viral replication and absent in growth-transformed human T cells. A comparative examination of HVS-transformed T-cell clones and their native parental clones revealed that the expression of Bcl-2, Bcl-X(L), Bax, and members of the tumor necrosis factor receptor (TNF-R) superfamily with a death domain, namely, TNF-RI, CD95, and TRAMP, were not modulated by HVS. Expression of CD30 was induced in HVS-transformed T cells, and these cells also expressed the CD30 ligand. Uninfected and transformed T cells were sensitive to CD95 ligation but resistant to apoptosis mediated by TRAIL or soluble TNF-alpha. CD95 ligand was constitutively expressed on transformed but not uninfected parental T cells. Both cell types showed similar sensitivity to cell death induction or inhibition of T-cell activation mediated by irradiation, oxygen radicals, dexamethasone, cyclosporine, and prostaglandin E2. Altogether, this study strongly suggests that growth transformation by HVS is based not on resistance to apoptosis but, rather, on utilization of normal cellular activation pathways.

A periodogram-based method for the detection of steady-state visually evoked potentials

The task of objective perimetry is to scan the visual field and find an answer about the function of the visual system. Flicker-burst stimulation--a physiological sensible combination of transient and steady-state stimulation--is used to generate deterministic sinusoidal responses or visually evoked potentials (VEP's) at the visual cortex, which are derived from the electroencephalogram by a suitable electrode array. In this paper we develop a new method for the detection of VEP's. Based on the periodogram of a time-series, we test the data for the presence of hidden periodic components, which correspond to steady-state VEP's. The method is applied successfully to real data.

[Survival after poisoning due to intake of ten-times lethal dose of acetone]

HISTORY AND ADMISSION FINDINGS

A 42-year-old man was found unconscious, having swallowed 800 ml of an unknown liquid with suicidal intent. On admission, when his breath smelled strongly of acetone, he was intubated and ventilated, and several gastric lavages were performed.

INVESTIGATION

The serum acetone concentration was 2000 mg/l, that in urine 2300 mg/l. The residue of the liquid in the bottle from which he had drunk was pure acetone.

DIAGNOSIS, TREATMENT AND COURSE

Acetone poisoning having been established he was carefully hyperventilated, haemofiltration was performed over 16 hours and forced diuresis with high fluid intake was undertaken. His condition quickly improved and he was extubated after 14 hours. There was no subsequent evidence of organ damage. Repeated measurements of acetone in blood and urine indicated its elimination with a half-life of 11 hours. Literature search revealed that this was the second highest concentration of acetone in blood and urine followed by survival.

CONCLUSION

This case demonstrates that, after acute acetone poisoning with an amount ten times the lethal dose, intensive care and rapid elimination of acetone can achieve sequelae-free survival.

[Experimental studies of locally generated focal VECP within the 30 degree visual field with LED]

Measuring and evaluating locally generated VECP present a chance to overcome methodical restriction in conventional subjective perimetry. To achieve this, stimuli are required which ensure the generation of detectable responses under controlled scattered light influence. The suitability of LED for this task was studied. LED stimuli (lambda = 560 nm) were moved in steps of 3 degrees from 0 degree to 30 degrees on the horizontal meridian within a perimeter sphere. The stimuli were 0.8 degree and 1.7 degrees in size, 20 ms in duration and 0.5 Hz in frequency. The background illumination was 10 cd/m2. A total 467 responses recorded from 20 volunteers (age 26 +/- 2) known to be free of any visual field defect have been evaluated. Using only one LED (size 0.8 degree) VECPs are detectable in the visual field < 9 degrees exclusively. An increase of stimuli size to 1.7 degrees made the generation of detectable VECP within the peripheral visual field possible. Statistical evaluation (sign test) proved significantly that VECP can be reliably elicited under LED stimulation. LED (lambda = 560 nm) are suitable for the generation of localized VECP in the visual field up to an eccentricity of 30 degrees.