Biomedical subjects
A Rauber
Publications and source records attributed to A Rauber.
Button batteries: letting the skeleton out of our closet.
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Ingestion of concentrated silver nitrate: a report of two cases.
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Observations on the idioblasts of Dieffenbachia.
The toxicity of the Arum genus, especially the Dieffenbachia, has long been a topic of controversy. Some believe that the injury inflicted is primarily mechanical, the result of needle like crystals of calcium oxalate (raphides) found in the stems and leaves. Others cite evidence supporting the existence of enzymatic and allergic injury. This paper describes a hitherto neglected third factor, specialized cells which can forcibly shoot the raphides and which may be necessary for the toxic effect since raphide containing plants devoid of these cells are not toxic. The effects of physical and chemical factors on the behavior of these cells are described.
Castor bean toxicity re-examined: a new perspective.
Commonly used references present a very gloomy prognosis for castor seed ingestion. This appears to be based chiefly on extrapolations from laboratory animal studies of toxicity of the component, ricin. This is not in concordance with actual experience when actual case report experience is sought out and examined in detail. The literature has been confused by recursive references among secondary sources and mortality statistics have been distorted by reliance on data generated nearly a century ago which do not accurately reflect the capabilities of modern medical management. This is elucidated by actually tracking down and studying difficult-to-find original case reports from the early decades of the 20th century. It is time to reappraise our estimates of the hazard of ingesting castor seeds in the light of present day medical capabilities.
Safety closures after fifteen years.
Safety closures still are often the butt of jokes and many adults complain of inability to use CRCs. It has been suggested that pharmacists should devote more attention to instructing patients in the use of CRCs. We studied a random sample of adults (AC) and three "Golden Age" groups (GA). We measured the time taken in operating CRCs and the effect of training. For palm/turn CRCs there was no difference between AC and GA, or trained (T) and untrained (UT) groups. For "arrow" CRCs a significant (p less than .01) difference was found in all comparisons (UTAC vs TAC, UTGA vs TGA, UTAC vs UTGA, TAC vs TGA). The GA groups had difficulty seeing the white on white arrows but once found, could open the CRC with one hand and preferred this type CRC. This physical defect could not be overcome by training. All pretraining times were so short that training makes no important improvement. Improving visibility of characters on the CRC would be a greater utility.
Prescribing practices and knowledge of tricyclic antidepressants among physicians caring for children.
We did not find any significant difference between pediatricians and family practitioners with regard to their knowledge of the potentially serious toxicities of the tricyclic antidepressants. One of this group, imipramine, is in widespread use for the treatment of enuresis. A large proportion of the pediatricians (40%) and family practitioners (50%) surveyed use this drug as the first or only approach to enuresis. It is disquieting to discover that, of those physicians choosing to use the drug, one third appear to be unaware of its toxic potential. Other effective treatment modes are available, and it is to be hoped that more physicians will explore them before turning to the more hazardous pharmacologic alternatives. Pediatricians, although not more knowledgeable than family practitioners, exhibited more careful prescribing practices.
Poisoning in children under 12 months of age.
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Trends in childhood poisoning: a collaborative study 1970, 1975, 1980.
A collaborative study of 273 treated poisonings at three regional poison control centers showed a significant decrease in salicylism from 19% of all cases in 1970 to 9% in 1975 and 11% in 1980. A temporal correlation with safety packaging was also seen in the decrease in poisonings by household products from 36% and 42% of all treated poisonings in 1970 and 1975 to 21% in 1980. Poisonings by non-salicylate medications increased from 45% to 68% of treated ingestions. Therapeutic mishaps were relatively constant at 27%, 20% and 20% of all poisonings by medications. In children under one year of age 59% of medicinal poisonings were therapeutic mishaps, significantly higher than the 27% incidence for ages 1 to 5 years. Therapeutic mishaps and ingestions of household products resulted in significantly longer hospitalizations than accidental ingestion of medications. Additional data from two other regional centers permitted analysis of a total of 47 cases of treated salicylism. Therapeutic mishaps showed a possible upward trend from 27% of salicylate poisonings in 1970 to 36% in 1980. Almost all of the therapeutic mishaps with salicylates involved repeated overdose; 18 of the 19 mishaps due to other medications were allergic reactions.
Black widow spider bites.
Black widow spiders (Latrodectus species) are found worldwide. Envenomation of humans usually occurs as the result of chance intrusion into the spider's domain by the human. The venom is regarded as one of the most potent biologic toxins. The venom acts by destabilization of cell membranes and degranulation of nerve terminals resulting in the release of neurotransmitters. The clinical picture is characterized by painful muscle spasm and hypertension. The very young, the elderly or enfeebled, and those with cardiovascular disease are at greatest risk. While not always necessary, the most effective treatment is specific antiserum. Muscle relaxants, analgesics and intravenous calcium are useful adjuvant treatment.