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Ja-liang Lin - One of the best experts on this subject based on the ideXlab platform.
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Paraquat Poisoning in pediatric patients.
Pediatric emergency care, 2013Co-Authors: Yi-wen Hsieh, Ja-liang Lin, Shen-yang Lee, Cheng-hao Weng, Huang-yu Yang, Shou-hsuan Liu, I-kuan Wang, Chih-chia Liang, Chiz Tzung Chang, Tzung-hai YenAbstract:OBJECTIVE: This observational study examined the outcome of Taiwanese pediatric patients with Paraquat Poisoning and compared these data with the published data on Paraquat Poisonings from other international Poisoning centers. METHODS: We performed a retrospective study on children with acute Paraquat Poisoning that were admitted to the Chang Gung Memorial Hospital during a period of 10 years (2000-2010). Of the 193 Paraquat Poisoning patients, only 6 were children. RESULTS: The mean age was 8.85 ± 5.55 (1-15.6) years. Younger patients had accidentally swallowed Paraquat, whereas older patients had intentionally ingested Paraquat. Most patients were referred within a relatively short period (0.5-2.0 hours). Paraquat Poisoning was associated with high morbidity and often resulted in severe complications, including acute respiratory distress syndrome and multiple-organ failure. The complications included shock (50.0%), hypoxemia (33.3%), respiratory failure (33.3%), nausea/vomiting (16.7%), abdominal pain (33.3%), hepatitis (66.7%), gastrointestinal tract bleeding (33.3%), acute renal failure (33.3%), and seizures (16.7%). Patients were treated aggressively with a standard detoxification protocol consisting of gastric lavage, active charcoal, charcoal hemoperfusion, and cyclophosphamide and steroid pulse therapies. Secondary bacterial infections were common after hospitalization and included sepsis (33.3%), pneumonia (33.3%), and urinary tract infection (50.0%). In the end, 2 patients (33.3%) died from multiple-organ failure, despite intensive resuscitation. CONCLUSIONS: Our data (mortality rate, 33.3%) are comparable to the data of other published reports from other international poison centers. Evidently, a prompt diagnosis of Paraquat Poisoning and an immediate institution of a detoxification protocol is a prerequisite for a favorable outcome. Language: en
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repeated pulse of methylprednisolone and cyclophosphamide with continuous dexamethasone therapy for patients with severe Paraquat Poisoning
Critical Care Medicine, 2006Co-Authors: Ja-liang Lin, Kuan-hsing Chen, Dantzu Lintan, Wen-hung HuangAbstract:Objective:Paraquat is widely used in the world, and all treatments for Paraquat Poisoning have been unsuccessful. Many patients have died of Paraquat Poisoning in developing countries. A novel anti-inflammation method was developed to treat severe Paraquat-poisoned patients with >50% to <90% predict
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Repeated pulse of methylprednisolone and cyclophosphamide with continuous dexamethasone therapy for patients with severe Paraquat Poisoning.
Critical care medicine, 2006Co-Authors: Ja-liang Lin, Dan-tzu Lin-tan, Kuan-hsing Chen, Wen-hung HuangAbstract:Objective:Paraquat is widely used in the world, and all treatments for Paraquat Poisoning have been unsuccessful. Many patients have died of Paraquat Poisoning in developing countries. A novel anti-inflammation method was developed to treat severe Paraquat-poisoned patients with >50% to
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Combined methylprednisolone and dexamethasone therapy for Paraquat Poisoning.
Critical care medicine, 2002Co-Authors: Guan-hsing Chen, Ja-liang Lin, Yao-kuang HuangAbstract:Objective: To report a severe case of Paraquat Poisoning successfully treated with repeated-pulse therapy of methylprednisolone. Design: Case study. Setting: University Hospital, Lin-Kou Medical Center, Taipei, Taiwan, Republic of China. Patients: A 60-yr-old man with Paraquat Poisoning with severe acute renal failure (serum creatinine level of 11.8 mg/dL and serum Paraquat level of 3.66 μg/mL at 10 hrs after ingestion) and severe hypoxemia (Pao 2 , 66.6 mm Hg). Intervention: Repeated 3-day pulse therapy with methylprednisolone, one course of 2-day cyclophosphamide, and a high dose of dexamethasone for 33 days. Measurements and Main Outcome: Arterial blood gas analysis was obtained regularly. A chest radiography was obtained every week. The arterial blood oxygen concentrations dramatically elevated from 66 mm Hg to 97 mm Hg, and the chest radiographs markedly improved after repeated-pulse therapy with anti-inflammatory agents and cyclophosphamide. Conclusions: We successfully treated a severe Paraquat poisoned patient with repeated methylprednisolone pulse therapy and prolonged dexamethasone treatment. This case demonstrates that the severe inflammation, not the fibrosis, of the lungs plays a major role in the lethal hypoxemia of patients with Paraquat Poisoning during the subacute period and confirms our previous hypotheses. Clearly, the use of anti-inflammatory therapy to treat Paraquat-poisoned patients needs further evaluation; however, anti-inflammatory therapy may be an effective treatment after failure of standard therapies.
Wen-hung Huang - One of the best experts on this subject based on the ideXlab platform.
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repeated pulse of methylprednisolone and cyclophosphamide with continuous dexamethasone therapy for patients with severe Paraquat Poisoning
Critical Care Medicine, 2006Co-Authors: Ja-liang Lin, Kuan-hsing Chen, Dantzu Lintan, Wen-hung HuangAbstract:Objective:Paraquat is widely used in the world, and all treatments for Paraquat Poisoning have been unsuccessful. Many patients have died of Paraquat Poisoning in developing countries. A novel anti-inflammation method was developed to treat severe Paraquat-poisoned patients with >50% to <90% predict
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Repeated pulse of methylprednisolone and cyclophosphamide with continuous dexamethasone therapy for patients with severe Paraquat Poisoning.
Critical care medicine, 2006Co-Authors: Ja-liang Lin, Dan-tzu Lin-tan, Kuan-hsing Chen, Wen-hung HuangAbstract:Objective:Paraquat is widely used in the world, and all treatments for Paraquat Poisoning have been unsuccessful. Many patients have died of Paraquat Poisoning in developing countries. A novel anti-inflammation method was developed to treat severe Paraquat-poisoned patients with >50% to
Yao-kuang Huang - One of the best experts on this subject based on the ideXlab platform.
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Combined methylprednisolone and dexamethasone therapy for Paraquat Poisoning.
Critical care medicine, 2002Co-Authors: Guan-hsing Chen, Ja-liang Lin, Yao-kuang HuangAbstract:Objective: To report a severe case of Paraquat Poisoning successfully treated with repeated-pulse therapy of methylprednisolone. Design: Case study. Setting: University Hospital, Lin-Kou Medical Center, Taipei, Taiwan, Republic of China. Patients: A 60-yr-old man with Paraquat Poisoning with severe acute renal failure (serum creatinine level of 11.8 mg/dL and serum Paraquat level of 3.66 μg/mL at 10 hrs after ingestion) and severe hypoxemia (Pao 2 , 66.6 mm Hg). Intervention: Repeated 3-day pulse therapy with methylprednisolone, one course of 2-day cyclophosphamide, and a high dose of dexamethasone for 33 days. Measurements and Main Outcome: Arterial blood gas analysis was obtained regularly. A chest radiography was obtained every week. The arterial blood oxygen concentrations dramatically elevated from 66 mm Hg to 97 mm Hg, and the chest radiographs markedly improved after repeated-pulse therapy with anti-inflammatory agents and cyclophosphamide. Conclusions: We successfully treated a severe Paraquat poisoned patient with repeated methylprednisolone pulse therapy and prolonged dexamethasone treatment. This case demonstrates that the severe inflammation, not the fibrosis, of the lungs plays a major role in the lethal hypoxemia of patients with Paraquat Poisoning during the subacute period and confirms our previous hypotheses. Clearly, the use of anti-inflammatory therapy to treat Paraquat-poisoned patients needs further evaluation; however, anti-inflammatory therapy may be an effective treatment after failure of standard therapies.
Sae-yong Hong - One of the best experts on this subject based on the ideXlab platform.
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prediction of patient survival in cases of acute Paraquat Poisoning
PLOS ONE, 2014Co-Authors: Sae-yong Hong, Jisung Lee, In O Sun, Kwangyoung Lee, Hyo-wook GilAbstract:Paraquat concentration-time data have been used to predict the clinical outcome following ingestion. However, these studies have included only small populations, although Paraquat Poisoning has a very high mortality rate. The purpose of this study was to develop a simple and reliable model to predict survival according to the time interval post-ingestion in patients with acute Paraquat Poisoning. Data were retrospectively collected for patients who were admitted with Paraquat Poisoning to Soonchunhyang University Choenan Hospital between January 2005 and December 2012. Plasma Paraquat levels were measured using high-performance liquid chromatography. To validate the model we developed, we used external data from 788 subjects admitted to the Presbyterian Medical Center, Jeonju, Korea, between January 2007 and December 2012. Two thousand one hundred thirty six patients were included in this study. The overall survival rate was 44% (939/2136). The probability of survival for any specified time and concentration could be predicted as (exp(logit))/(1+exp(logit)), where logit = 1.3544+[-3.4688 × log10(plasma Paraquat μg/M[Formula: see text])]+[-2.3169 × log10(hours since ingestion)]. The external validation study showed that our model was highly accurate for the prediction of survival (C statics 0.964; 95% CI [0.952-0.975]). We have developed a model that is effective for predicting survival after Paraquat intoxication.
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Association between plasma Paraquat level and outcome of Paraquat Poisoning in 375 Paraquat Poisoning patients.
Clinical toxicology (Philadelphia Pa.), 2008Co-Authors: Hyo-wook Gil, Eun Young Lee, Jong-oh Yang, Mun-soo Kang, Sae-yong HongAbstract:Objectives. Paraquat Poisoning by ingestion is often fatal. Many studies have investigated treatment modalities and predictor parameters, but there is no standard treatment. Plasma Paraquat concentration seems a valid predictable parameter of survival. In order to achieve uniform treatment, including extracorporeal elimination and antioxidant therapy, the outcome of Paraquat Poisoning based on plasma Paraquat level needs to be investigated. Methods. This study included 375 Paraquat Poisoning patients who were diagnosed by means of plasma Paraquat concentration within 24 hours after ingestion in the Institute of Pesticide Poisoning of Soonchunhyang University Cheonan Hospital, Korea, from January 2005 to December 2006. All patients were treated according to a uniform protocol including extracorporeal elimination and antioxidant therapy. Plasma Paraquat concentration was measured by high-performance liquid chromatography. Results. The mean age of the Paraquat-intoxicated patients was 48.42 ± 6.75. One hundr...
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Predictors of survival after acute Paraquat Poisoning
Toxicology and industrial health, 2002Co-Authors: Eun Young Lee, Kyu-yoon Hwang, Jong-oh Yang, Sae-yong HongAbstract:Acute Paraquat Poisoning is often fatal. Many studies have investigated successful treatment modalities, but no standard treatment yet exists. The purpose of this study was to determine the predictors of survival after acute Paraquat Poisoning in 602 patients. The Paraquat exposure was assessed based on the amount of ingested Paraquat and a semiquantitative measure of the urine level of Paraquat. Initial clinical parameters including vital signs, hemoglobin, white-blood-cell count, pH, PaCO2, PaO2, blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, total bilirubin, amylase, and glucose were obtained at the time of arrival at the emergency room. Outcomes after acute Paraquat Poisoning were categorized as survivors and nonsurvivors. Multiple logistic regression analysis was applied to assess the predictors of survival after acute Paraquat Poisoning. Some patients (55.5%) survived after oral ingestion of Paraquat, whereas all those exposed to Paraquat percutaneous or inhalational route survived. The amount of Paraquat (24.5% concentrate of 1,1'-dimethyl-4,4'-bipyridium dichloride) ingested was 45.6 +/- 74.1 mL (mean +/- SD). In addition to degree of Paraquat exposure, survival after acute Paraquat Poisoning was associated with age, respiratory rate, pH, PaCO2, hemoglobin, white-blood-cell count, blood urea nitrogen, amylase, and the number of failed organs in multiple logistic regression analysis. In conclusion, young age, percutaneous or inhalational route, exposure to less Paraquat, and lesser degrees of leukocytosis, acidosis, and renal, hepatic, and pancreatic failures on admission are good prognostic factors of survival after acute Paraquat Poisoning.
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Paraquat Poisoning of the lung: thin-section CT findings.
Radiology, 1995Co-Authors: Sang Hun Lee, Kyung Soo Lee, Joong Mo Ahn, Sae Hun Kim, Sae-yong HongAbstract:PURPOSE: To describe thin-section computed tomographic (CT) findings in Paraquat Poisoning of the lung. MATERIALS AND METHODS: Thin-section CT scans of the lungs in 16 patients with Paraquat Poisoning were reviewed. The patients were nine male and seven female persons whose ages ranged from 16 to 74 years (mean, 29 years). Follow-up CT scans were available for seven patients. RESULTS: The most common pattern on initial scans was ground-glass attenuation, present alone or as part of a mixed pattern in 13 patients. It was bilateral and diffuse in distribution. Consolidation was present in six patients, irregular lines in three, and nodules in two patients. On follow-up scans, the ground-glass attenuation had changed to consolidation with bronchiectasis. Additional irregular lines and traction bronchiectasis also were observed. CONCLUSION: CT findings in Paraquat Poisoning of the lung begin with ground-glass attenuation, which leads to consolidation with bronchiectasis or irregular lines.
Y. C. Liu - One of the best experts on this subject based on the ideXlab platform.
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Pulse therapy with cyclophosphamide and methylprednisolone in patients with moderate to severe Paraquat Poisoning: a preliminary report.
Thorax, 1996Co-Authors: J. L. Lin, M. C. Wei, Y. C. LiuAbstract:BACKGROUND: Severe Paraquat Poisoning causes considerable morbidity and mortality. High doses of cyclophosphamide and dexamethasone have been used to treat patients with Paraquat Poisoning, but with mixed results. The use of pulse methylprednisolone and cyclophosphamide was investigated in the treatment of moderately severe Paraquat Poisoning. METHODS: During a six-year period 87 patients with Paraquat Poisoning were admitted to hospital, of whom 33 had moderate to severe intoxication. Seventeen patients received conventional treatment and served as historical controls, and 16 received intravenous infusions of cyclophosphamide 1 g daily for two days and methylprednisolone 1 g daily for three days. RESULTS: There were no differences between the groups in age, sex, severity of Paraquat Poisoning (as assessed by urine dithionite tests), or in the time elapsed from ingestion to presentation at hospital or to the beginning of haemoperfusion. No differences were seen in biochemical measurements on the third day after Paraquat Poisoning. The mortality in the pulse therapy group was lower than that in the control group (4/16 (25%) versus 12/17 (70.6%), p = 0.01). All fatalities were from progressive respiratory failure. CONCLUSIONS: Pulse therapy with cyclophosphamide and methylprednisolone may be effective in preventing respiratory failure and reducing mortality in patients with moderate to severe Paraquat Poisoning. Further controlled studies are needed to confirm this and to establish the mechanisms.
