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Betel nut poisoning in Taiwan
Abstracts
501
l?ffec~~of hunnalgesin from king cobra (Ophiophagus hannah) venom on structure andfunction of rat annococcygeus muscle. X. C. Pu,’ P. Gopalakrishnakone’ and P. T. H. Wang* (Venom and Toxin Research Group, Departments of ‘Anatomy and LPharmacology, Faculty of Medicine, National University of Singapore, Singapore 119260). We have observed that on the isolated rat annococcygeus muscle (Acm), precontracted with carbachol in the presence of phentolamine, hannalgesin caused relaxation of the muscle. In a further study, it was demonstrated that the relaxations induced by hannalgesin could be inhibited by L-NAME (a specific NO-synthase inhibitor), haemoglobin and Methylene Blue, which, respectively, inhibits guanylate cyclase activation and binds NO. These results implied that effect of hannalgesin on the Acm was related to the production of NO and subsequent formation of cyclic GMP (NO stimulates the enzyme guanylate cyclase). After exposure to hannalgesin for 3 hr. morphological studies were carried out on the Acm under the electron microscope. The nerve varicosities were found to be damaged to different degrees. Severely damaged varicosities were swollen or even broken, with ‘exploded’ mitochondria and depletion of synaptic vesicles. Less severe damage included pyknotic changes such as shrunken elements with an electron-dense background. Hannalgesin apparently did not damage the muscle cells structurally. Only a few mitochondria appeared to be darker and swollen; some shrinking of the muscle cell membranes was also observed. The results of this study showed that hannalgesin caused Acm relaxation by way of NO, accompanied by structural changes of the muscle, mainly in nerve varicosities. Clinical features of wasp and bee stings in Taiwan. C.-C. Yang and J.-F. Deng (Division of Clinical Toxicology, Department of Medicine, VGH-Taipei, Taiwan, R.O.C.; and Department of Medicine, Faculty of Medicine. National Yang-Ming University, Taipei, Taiwan, R.O.C.). Wasp and bee stings cause various allergic and non-allergic reactions. In Taiwan, although hymenoptera stings are not uncommon, data concerning their toxicities on humans are scarce. To obtain a better view of their clinical features, a PCC-based study was conducted. From July 1985 to December 1995, all cases reported to the PCC-Taiwan as wasp or bee stings were reviewed. After excluding cases with inadequate information, all relevant data were analysed. A total of 294 cases was recruited. Among all the cases, wasp stings accounted for 137 cases and bee stings were responsible for 129 cases, with incriminated insects not defined in 28 cases. After stinging, all but three patients experienced some local symptoms, e.g. erythema, pain, and swelling which usually subsided in l-3 days with or without treatment. However, 47 patients, most of whom suffered multiple stings, developed various systemic effects, including headache, fever, vomiting, anaphylaxis, haemolysis, rhabdomyolysis, DIG, acute renal failure and liver dysfunction. Interestingly, myocardial infarction was noted in two patients, stroke in three, pulmonary oedema in two and death in five, after hymenoptera stings. Besides anaphylaxis. a single hymenoptera sting rarely causes serious effects. Nevertheless, multiple stings may cause severe toxic syndromes which could subsequently lead to fatalities. Avoidance of hymenoptera stings remains the cornerstone in treatment options, while proper treatment with epinephrine, antihistamines, haemodialysis, plasmapheresis. and other supportive measures are essential for life-saving in those patients already presenting with serious effects. Betel nut poisoning in Taiwan. C.-L. Huang, C-C. Yang and J.-F. Deng (Division of Clinical Toxicology, Department of Medicine, Veterans General Hospital, Taipei, Taiwan, R.O.C.; and Department of Medicine, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.). Betel nut (Areca Catechu) chewing has long been a tradition in Taiwan and southern Asia. Consumption of betel nuts is known to produce various sympathetic and parasympathetic effects. Besides autonomic manifestations, betel nut chewing also increases cerebral alertness and is used as a euphoric agent. Although the carcinogenic effects of betel nuts are well known, data concerning its toxicity remain scarce. To understand better the toxicity of betel nuts, a retrospective study was conducted. During the period from January 1988 to December 1995, all cases reported to the PCC-Taiwan as betel nut poisoning were recruited. All relevant information was then analysed. Ten cases, including seven men and three women, were recruited. All cases were aged between 21 and 60 years old. The amount ingested was usually low (four patients consumed one betel nut only), while one patient ingested the extract of some 100 betel nuts, manifesting with hypotension and abdominal colic. Except for one case with daily consumption of 30 betel nuts in whom hypertension and intracranial haemorrhage was documented, either autonomic or neurological dysfunction occurred rapidly after betel chewing. Among the symptoms and signs, dizziness was the most common symptom (5), followed by hypertension, palpitation (4). cold sweating (3), vomiting, dyspnea, tachycardia, abdominal pain and hypertension (2). Other symptoms and signs were headache, facial flush, coma, confusion, lip and hand numbness, angioedema, chest pain, warm sensation of throat and dry mouth. No fatalities occurred in this study and most cases recovered within 24 hr. Betel nut poisoning may cause various manifestations, of which cerebral and cardiovascular effects are the most important. Although anticholinergic drugs might have some clinical role, treatment of betel nut poisoning remains largely supportive. With timely resuscitation, a rapid and complete recovery could be anticipated. A clinical survey offish stings in Taiwan. S.-C. Liao, C.-C. Yang and J.-F. Deng (Division of Clinical Toxicology, Veterans General Hospital, Taipei, Taiwan, R.O.C.; and Department of Medicine, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.).
501
l?ffec~~of hunnalgesin from king cobra (Ophiophagus hannah) venom on structure andfunction of rat annococcygeus muscle. X. C. Pu,’ P. Gopalakrishnakone’ and P. T. H. Wang* (Venom and Toxin Research Group, Departments of ‘Anatomy and LPharmacology, Faculty of Medicine, National University of Singapore, Singapore 119260). We have observed that on the isolated rat annococcygeus muscle (Acm), precontracted with carbachol in the presence of phentolamine, hannalgesin caused relaxation of the muscle. In a further study, it was demonstrated that the relaxations induced by hannalgesin could be inhibited by L-NAME (a specific NO-synthase inhibitor), haemoglobin and Methylene Blue, which, respectively, inhibits guanylate cyclase activation and binds NO. These results implied that effect of hannalgesin on the Acm was related to the production of NO and subsequent formation of cyclic GMP (NO stimulates the enzyme guanylate cyclase). After exposure to hannalgesin for 3 hr. morphological studies were carried out on the Acm under the electron microscope. The nerve varicosities were found to be damaged to different degrees. Severely damaged varicosities were swollen or even broken, with ‘exploded’ mitochondria and depletion of synaptic vesicles. Less severe damage included pyknotic changes such as shrunken elements with an electron-dense background. Hannalgesin apparently did not damage the muscle cells structurally. Only a few mitochondria appeared to be darker and swollen; some shrinking of the muscle cell membranes was also observed. The results of this study showed that hannalgesin caused Acm relaxation by way of NO, accompanied by structural changes of the muscle, mainly in nerve varicosities. Clinical features of wasp and bee stings in Taiwan. C.-C. Yang and J.-F. Deng (Division of Clinical Toxicology, Department of Medicine, VGH-Taipei, Taiwan, R.O.C.; and Department of Medicine, Faculty of Medicine. National Yang-Ming University, Taipei, Taiwan, R.O.C.). Wasp and bee stings cause various allergic and non-allergic reactions. In Taiwan, although hymenoptera stings are not uncommon, data concerning their toxicities on humans are scarce. To obtain a better view of their clinical features, a PCC-based study was conducted. From July 1985 to December 1995, all cases reported to the PCC-Taiwan as wasp or bee stings were reviewed. After excluding cases with inadequate information, all relevant data were analysed. A total of 294 cases was recruited. Among all the cases, wasp stings accounted for 137 cases and bee stings were responsible for 129 cases, with incriminated insects not defined in 28 cases. After stinging, all but three patients experienced some local symptoms, e.g. erythema, pain, and swelling which usually subsided in l-3 days with or without treatment. However, 47 patients, most of whom suffered multiple stings, developed various systemic effects, including headache, fever, vomiting, anaphylaxis, haemolysis, rhabdomyolysis, DIG, acute renal failure and liver dysfunction. Interestingly, myocardial infarction was noted in two patients, stroke in three, pulmonary oedema in two and death in five, after hymenoptera stings. Besides anaphylaxis. a single hymenoptera sting rarely causes serious effects. Nevertheless, multiple stings may cause severe toxic syndromes which could subsequently lead to fatalities. Avoidance of hymenoptera stings remains the cornerstone in treatment options, while proper treatment with epinephrine, antihistamines, haemodialysis, plasmapheresis. and other supportive measures are essential for life-saving in those patients already presenting with serious effects. Betel nut poisoning in Taiwan. C.-L. Huang, C-C. Yang and J.-F. Deng (Division of Clinical Toxicology, Department of Medicine, Veterans General Hospital, Taipei, Taiwan, R.O.C.; and Department of Medicine, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.). Betel nut (Areca Catechu) chewing has long been a tradition in Taiwan and southern Asia. Consumption of betel nuts is known to produce various sympathetic and parasympathetic effects. Besides autonomic manifestations, betel nut chewing also increases cerebral alertness and is used as a euphoric agent. Although the carcinogenic effects of betel nuts are well known, data concerning its toxicity remain scarce. To understand better the toxicity of betel nuts, a retrospective study was conducted. During the period from January 1988 to December 1995, all cases reported to the PCC-Taiwan as betel nut poisoning were recruited. All relevant information was then analysed. Ten cases, including seven men and three women, were recruited. All cases were aged between 21 and 60 years old. The amount ingested was usually low (four patients consumed one betel nut only), while one patient ingested the extract of some 100 betel nuts, manifesting with hypotension and abdominal colic. Except for one case with daily consumption of 30 betel nuts in whom hypertension and intracranial haemorrhage was documented, either autonomic or neurological dysfunction occurred rapidly after betel chewing. Among the symptoms and signs, dizziness was the most common symptom (5), followed by hypertension, palpitation (4). cold sweating (3), vomiting, dyspnea, tachycardia, abdominal pain and hypertension (2). Other symptoms and signs were headache, facial flush, coma, confusion, lip and hand numbness, angioedema, chest pain, warm sensation of throat and dry mouth. No fatalities occurred in this study and most cases recovered within 24 hr. Betel nut poisoning may cause various manifestations, of which cerebral and cardiovascular effects are the most important. Although anticholinergic drugs might have some clinical role, treatment of betel nut poisoning remains largely supportive. With timely resuscitation, a rapid and complete recovery could be anticipated. A clinical survey offish stings in Taiwan. S.-C. Liao, C.-C. Yang and J.-F. Deng (Division of Clinical Toxicology, Veterans General Hospital, Taipei, Taiwan, R.O.C.; and Department of Medicine, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.).