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Management of poisoned patient requires accurate knowledge of intoxication. Uludao Poison Information Center (UPIC), founded in January 1996, provides acquired information 24 hours a day 7 days a week for physicians and consultants. We received 2270 phone calls since January 1996 till October 1998 and evaluated the cases statistically regarding "distribution of age and gender", "calling time after poison exposure", "source of poisoning", "reason for intoxication" and "source of calls" to reveal the distinguishing features of intoxication. Intoxication was mostly seen between 14-25 years of age (964 cases, 42.46%) and in females (1367 cases, 60.22%). Drugs (1400 cases, 61.67%) were the main source and suicide attempts (930 cases, 40.9%) were the main reason of poisoning. Most of the calls were from healthcare professionals (1347, 59.33%).

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Three methods of predicting difficult intubation were compared prospectively. Mallampati test, Wilson risk-sum and thyromental distance were determined preoperatively and laryngeal views were graded in 500 patients. The sensitivities, specificities, positive and negative predictive values of each test were calculated. The incidence of difficult intubation was found to be 8%. The sensitivities of the Mallampati test, the Wilson risk-sum and the thyromental distance were 43%, 58% and 35% respectively, and the specificities were 93%, 91% and 95% respectively. Significant differences were seen between the sensitivities of the Mallampati test and the Wilson risk-sum (P < 0.001), the Wilson risk-sum and the thyromental distance (P < 0.001), the Mallampati test and the thyromental distance (P < 0.05). Among the different specificities, the only significant difference was observed between the Wilson risk-sum and the thyromental distance (P < 0.05). There were no significant differences between the positive and negative predictive values of the three screening tests (P > 0.05). In conclusion, the Wilson risk-sum was the most sensitive test and the thyromental distance has the highest positive predictive value for difficult intubation.

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The serum levels of choline decreased by approximately 50% in patients having a surgery under general as well as epidural anesthesia. The decrease is lasts for two days after surgery. Intravenous administration of succinylcholine, either by a single bolus injection or by a slow continuous infusion, increased the serum choline levels several folds during surgery. In these patients, a significant decrease in the serum choline levels was observed one and two days after surgery. In 16 pregnant women at the term, serum choline levels were higher than the value observed in 19 nonpregnant women. The serum choline levels decreased by about 40% or 60% after having a childbirth either by vaginal delivery or caesarean section, respectively. Serum choline levels in blood obtained from 9 patients with traumatic head injury were significantly lower than the observed levels in blood samples obtained from healthy volunteers. These observations show that serum choline levels increase during pregnancy and decrease during stressful situations in humans.

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A case of organophosphate poisoning is presented by using Tc-99m HMPAO (hexamethyl propylenamine oxime) brain SPECT (single photon emission computer tomography) and Tc-99m Sestamibi myocardial SPECT findings in the acute recovery and delayed phases. On the 4th day, brain SPECT imaging showed the perfusion defects in the left parietal lobe of the brain. On the 5th day myocardium scintigraphy also revealed the anterolateral wall perfusion defect. The myocardial defect became more prominent but brain defect was smaller than before, on the 19th day of the therapy. Two months later, on the third examinations of the brain and myocardium, their imagings were both normal.

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Organophosphate poisonings cause substantial morbidity and mortality worldwide; however, the neurological effects have not been clearly established. We have studied cerebral perfusion to investigate neurotoxic effects. Clinical effects, plasma cholinesterase activity, and brain single photon emission computerization tomography (SPECT) data were investigated in 16 patients with organophosphate poisonings. The subjects were from an adult intensive care unit in a university hospital. Cholinesterase activity in plasma was determined upon admission and then every day in the morning. Brain SPECT studies were performed during the first week, at the end of therapy, and 3 months after discharge. Patients were classified into 3 groups using a modified Namba classification: latent poisoning (Group A); mild and moderate poisoning (Group B); or severe poisoning (Group C). None of the 6 patients in Group A showed any symptoms; 3 patients in Group B had muscarinic and nicotinic effects; 5 patients in Group C had muscarinic, nicotinic, and central nervous system symptoms. The average plasma cholinesterase for Groups A, B, and C were 54.16 +/- 9.10, 42.2 +/- 12.02, and 13 +/- 4.84 U/ml, respectively (normal range of plasma cholinesterase is 40-80 U/ml). Only 1 patient from Group A required treatment with oxime; 2 patients from Group B and all patients in Group C were given oxime, atropine sulfate, and mechanical ventilation. In the brain SPECT studies, the patients in Group A showed fewer perfusion defect areas than did Group B and C patients. All cases showed perfusion defects especially in the parietal lobe. In addition, perfusion improvement took more time for Group C than for the other groups. The intensive care unit stays of Group C were statistically longer than for Groups A and B. We concluded that brain SPECT is a highly sensitive diagnostic method, together with clinical symptoms and plasma cholinesterase activity, for monitoring the clinical prognosis of organophosphate poisonings.

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Two cases of organophosphate poisoning are presented along with Tc-99m HMPAO brain SPECT findings in the acute and delayed phases. Perfusion defects were more prominent at the onset of poisoning in both cases.

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