Severe fenitrothion poisoning complicated by rhabdomyolysis in psychiatric patient.

Non-traumatic rhabdomyolysis associated with organophosphate intoxication has not been generally reported. We report here in a severe case of fenitrothion poisoning complicated by rhabdomyolysis. A 43-year-old woman ingested approximately 100 ml of fenitrothion emulsion (50%) in an attempt to commit suicide. On day 3 after admission, her creatine phosphokinase (CPK) peaked at 47,762 IU/L. She received supportive treatment included sodium bicarbonate and fluid resuscitation. However, muscarinic symptoms including excessive miosis and salivation developed on day 5 when her CPK levels decreased. The delay in cholinergic symptoms might have been due to the trihexyphenidyl she took with the antipsychotic drugs. Fortunately, the present patient recovered from the acute cholinergic crisis, and acute renal failure was prevented by early diagnosis. This is a case of organophosphate poisoning complicated by rhabdomyolysis in a psychiatric patient. The masking of acute cholinergic symptoms should be taken into consideration in such patients.</p

Effect of chest tube position on the success rate of pleurodesis: A retrospective cohort study

Background: Malignant pleural effusion reduces cancer patients’ quality of life. Some experts have suggested that chest tubes should be directed posteriorly during pleurodesis. We conducted this study to clarify whether a posteriorly positioned chest tube has a better success rate than does an interlobular or anterior one. Methods: We performed a retrospective chart review of patients undergoing pleurodesis between April 2011 and September 2016, and 86 patients were enrolled and divided into two groups based on the chest tube position: posterior (group 1) and others [interlobular and anterior (group 2)]. The primary endpoint was the success rate of pleurodesis, and the secondary endpoint was the complication rate (pain and fever). P < 0.05 was considered to be significant. Results: In total, 66, 20 patients were included in groups 1 and 2, respectively. Complete and partial success was achieved in 57 (86%) and 15 (75%) patients in groups 1 and 2, respectively. The success rates were similar in all groups (p = 0.39). Complications were observed in 51 (77%) and 16 (80%) patients in groups 1 and 2, respectively (p = 0.99). Between the two groups, there was no statistically significant difference in terms of age and sex. Conclusions: In malignant pleural effusion, the success rates of pleurodesis may be similar regardless of the position of the tube. However, this is a retrospective study with insufficient participants. Hence, further investigation is required

Data from: Pleural effusion biomarkers and computed tomography findings in diagnosing malignant pleural mesothelioma: a retrospective study in a single center

In this study, we aimed to examine the clinical value of the pleural effusion (PE) biomarkers, soluble mesothelin-related peptide (SMRP), cytokeratin 19 fragment (CYFRA 21-1) and carcinoembryonic antigen (CEA), and the utility of combining chest computed tomography (CT) findings with these biomarkers, in diagnosing malignant pleural mesothelioma (MPM). We conducted a retrospective cohort study in a single center. Consecutive patients with undiagnosed pleural effusions who underwent PE analysis between September 2014 and August 2016 were reviewed. This study included 240 patients (32 with MPM and 208 non-MPM). SMRP and the CYFRA 21-1/CEA ratio had a sensitivity and specificity for diagnosing MPM of 56.3% and 86.5%, and 87.5% and 74.0%, respectively. Using receiver operating characteristics (ROC) curve analysis of the ability of these markers to distinguish MPM from all other PE causes, the area under the ROC curve (AUC) for SMRP and the CYFRA 21-1/CEA ratio was 0.804 and 0.874, respectively. The sensitivity and specificity of SMRP combined with the CYFRA 21-1/CEA ratio were 93.8% and 64.9%, respectively. The sensitivity of the combination of SMRP, the CYFRA 21-1/CEA ratio, and the presence of Leung's criteria (a chest CT finding that is suggestive of malignant pleural disease) was 93.8%. In conclusion, the combined PE biomarkers had a high sensitivity for diagnosing MPM, although the addition of chest CT findings did not improve the sensitivity of SMRP combined with the CYFRA 21-1/CEA ratio. Combination of these biomarkers helped to rule out MPM effectively among patients at high risk of suffering MPM and would be valuable especially for old frail patients who have difficulty in undergoing invasive procedures such as thoracoscopy