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Fatal sardine poisoning
THE sTRUCTURE of a minor alkaloid of Bocconia cordata has been deduced as protopine-N-oxide by spectroscopic methods and wnfirmed by synthesis . (Author's abstract)
H. P. KOLM
CLAVTOx, W. F., RE~SMAN, R. E., GEORGITIS, J. W., WYPYCH, J. I. and ARBESMAx, C. E. Effect of prolonged venom immunotherapy on serum-specific IgE and IgG. Clin. Allergy 13, 301 (1983) . Us~xa the radioallergosorbent test (RAST) the authors studied the immunological effects of venom immunotherapy, as shown by venom-specific IgE and IgG. This was done in patients receiving desensitization shots over a 3 year period . They concluded that such therapyresulted in two different serum venom-specific IgE responses in atopic individuals. One response is a persistent dxline in serum antibody titers, and the other is a specific rise in serum venom-specific IgE antibody titers followed by a decline in these titers . The authors discuss the significance of these findings . F. E. RUSSELL BLAKESLEV, M. L. Swmbroid poisoning: prompt resolution of symptoms with cimetidine . Ann. emerg. Med. 12, 104 (1983) . FouR CASES of scombroid poisoning were treated with cimetidine, 300 mg i.v . over a 3 - 30 min period, with quick resolution of most symptoms . In several of these patients other medications were tried prior to the administration of the cimetidine, but with unimpressive results . The present reviewer has successfully treated many scombroid poisonings with cyproheptadine hydrochloride, but the results have not been as dramatic as those presented by Blakesley. On the basis of his findings, cimetidine should be given a further clinical trial. F. E. RUSSELL MELTON, R. J., RANDALL, J. E., FusETANi, N., WEINER, R. S., CoucH, R. D. and $CMS, J. K. Fatal sardine poisoning. Hawaii Med. J. 43, 114 (1984) . A 67-YEAR-0LD male on Kauai, Hawaii, experienced cramping abdominal pain and subsequent diarrhea 30 min after eating sardines (Solar crumenophthalmus). Several hours later he had trouble walking, complained of chills and sweating and numbness in the arms and legs . He had four episodes of diarrhea within 4 hr, displayed abnormal anxiety and was slapping his face, arms and legs complaining of numbness and soreness . On examination, approximately S hr after eating the fish, his pulse was 53, B.P . 162/70 and respirations 16 . His body temperature was below normal and he had increased bowel sounds . However, the patient's condition deteriorated, he became delirious and unwntrollable, developed a thready pulse of 56, B.P . 90/0 , displayed tetanic contractions and carpopedal spasms . These were followed by cyanosis and cardiac arrest. In spite of intensive therapy the patient expired. This is an excellent clinical presentation with a good review of dupeoid poisoning. F. E. RUSSELL BALFOUR, D. J. K., Ed. International Encyclopedia oJPharmacology and Theraptutics, Section 114: Nicotine and the Tobocco Smoking Habit. 221 pp . ISBN 0-08-030779-5. Oxford : Pergamon Press. FOR EVERY adult in the world there are more than one thousand cigarettes smoked each year. In terms of the health consequences, the cigarette is now by far the most important form in which tobacco is used, and it may be wnduded that cigarette Smoking constitutes the largest single remaining preventable cause of death and disease. Nicotine thus is one of the most important plant toxins . In this book the various facets of nicotine and smoking have been reviewed, in detail : resorption and fate of nicotine, actions of nicotine and smoking on circulation, the properties of brain niwtine receptors, pharmacological responses to the intracerebral administration of nicotine, effects of nicotine on brain neurotransmitter systems, effects of nicotine on behaviour, pharmacology of nicotine dependence, smoking nicotine and human performance, human smoking behaviour and development of dependence, medical problems associated with smoking, and smoking and drug metabolism . This volume g nmm~ri~rs the data currently available in the topics mentioned. It is written clearly, and although concise, it is plentiful in information . For readers who want to go into details, big reference lists are given at the end of each chapter. Clinical and health problems are discussed in detail, and the aspects of dependence and of human behaviour are most interesting. On the other hand, however, the volume would have been of even more valueif a chapter on the chemistry of the smoke could have been included . Certainly, it is not only nicotine which is responsible for the symptoms, but also synergistic effects . Nevtrtheless, this volume gives much important information, for the layman as well as for the specialist, and it should not be missing from any medical, pharmacological, chemical or biological library . G. G. HABERMEHL
H. P. KOLM
CLAVTOx, W. F., RE~SMAN, R. E., GEORGITIS, J. W., WYPYCH, J. I. and ARBESMAx, C. E. Effect of prolonged venom immunotherapy on serum-specific IgE and IgG. Clin. Allergy 13, 301 (1983) . Us~xa the radioallergosorbent test (RAST) the authors studied the immunological effects of venom immunotherapy, as shown by venom-specific IgE and IgG. This was done in patients receiving desensitization shots over a 3 year period . They concluded that such therapyresulted in two different serum venom-specific IgE responses in atopic individuals. One response is a persistent dxline in serum antibody titers, and the other is a specific rise in serum venom-specific IgE antibody titers followed by a decline in these titers . The authors discuss the significance of these findings . F. E. RUSSELL BLAKESLEV, M. L. Swmbroid poisoning: prompt resolution of symptoms with cimetidine . Ann. emerg. Med. 12, 104 (1983) . FouR CASES of scombroid poisoning were treated with cimetidine, 300 mg i.v . over a 3 - 30 min period, with quick resolution of most symptoms . In several of these patients other medications were tried prior to the administration of the cimetidine, but with unimpressive results . The present reviewer has successfully treated many scombroid poisonings with cyproheptadine hydrochloride, but the results have not been as dramatic as those presented by Blakesley. On the basis of his findings, cimetidine should be given a further clinical trial. F. E. RUSSELL MELTON, R. J., RANDALL, J. E., FusETANi, N., WEINER, R. S., CoucH, R. D. and $CMS, J. K. Fatal sardine poisoning. Hawaii Med. J. 43, 114 (1984) . A 67-YEAR-0LD male on Kauai, Hawaii, experienced cramping abdominal pain and subsequent diarrhea 30 min after eating sardines (Solar crumenophthalmus). Several hours later he had trouble walking, complained of chills and sweating and numbness in the arms and legs . He had four episodes of diarrhea within 4 hr, displayed abnormal anxiety and was slapping his face, arms and legs complaining of numbness and soreness . On examination, approximately S hr after eating the fish, his pulse was 53, B.P . 162/70 and respirations 16 . His body temperature was below normal and he had increased bowel sounds . However, the patient's condition deteriorated, he became delirious and unwntrollable, developed a thready pulse of 56, B.P . 90/0 , displayed tetanic contractions and carpopedal spasms . These were followed by cyanosis and cardiac arrest. In spite of intensive therapy the patient expired. This is an excellent clinical presentation with a good review of dupeoid poisoning. F. E. RUSSELL BALFOUR, D. J. K., Ed. International Encyclopedia oJPharmacology and Theraptutics, Section 114: Nicotine and the Tobocco Smoking Habit. 221 pp . ISBN 0-08-030779-5. Oxford : Pergamon Press. FOR EVERY adult in the world there are more than one thousand cigarettes smoked each year. In terms of the health consequences, the cigarette is now by far the most important form in which tobacco is used, and it may be wnduded that cigarette Smoking constitutes the largest single remaining preventable cause of death and disease. Nicotine thus is one of the most important plant toxins . In this book the various facets of nicotine and smoking have been reviewed, in detail : resorption and fate of nicotine, actions of nicotine and smoking on circulation, the properties of brain niwtine receptors, pharmacological responses to the intracerebral administration of nicotine, effects of nicotine on brain neurotransmitter systems, effects of nicotine on behaviour, pharmacology of nicotine dependence, smoking nicotine and human performance, human smoking behaviour and development of dependence, medical problems associated with smoking, and smoking and drug metabolism . This volume g nmm~ri~rs the data currently available in the topics mentioned. It is written clearly, and although concise, it is plentiful in information . For readers who want to go into details, big reference lists are given at the end of each chapter. Clinical and health problems are discussed in detail, and the aspects of dependence and of human behaviour are most interesting. On the other hand, however, the volume would have been of even more valueif a chapter on the chemistry of the smoke could have been included . Certainly, it is not only nicotine which is responsible for the symptoms, but also synergistic effects . Nevtrtheless, this volume gives much important information, for the layman as well as for the specialist, and it should not be missing from any medical, pharmacological, chemical or biological library . G. G. HABERMEHL