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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2008.03.016 Byline: Adeline Ngo (a)(b), Michael Ciranni (c), Kent R. Olson (a)(d) Abstract: To describe clinical effects and outcome after acute quetiapine overdose in adults and compare these with overdose by all other antipsychotic drugs as a group. Author Affiliation: (a) California Poison Control System, San Francisco Division, San Francisco, CA (b) Emergency Department, Singapore General Hospital, Republic of Singapore (c) Department of Psychiatry, New York University, New York, NY (d) Departments of Medicine and Clinical Pharmacy and Division of Clinical Pharmacology, University of California, San Francisco, San Francisco, CA Article History: Received 7 January 2008; Revised 4 March 2008; Revised 13 March 2008; Accepted 17 March 2008 Article Note: (footnote) Supervising editor: E. Martin Caravati, MD, MPH, Author contributions: Each of the authors made substantial contributions to conception and design and analysis and interpretation of the data; had a role in drafting the article or revising it critically for important intellectual content; and approved of the version to be published. AN and KRO conceived of and designed the study and obtained consent from the University of California, San Francisco Committee on Human Research. AN, MC, and KRO were responsible for data collection, and KRO supervised conduct of the study. AN, MC, and KRO performed data analysis and interpretation. AN drafted the article, MC and KRO provided significant input, and KRO contributed substantially to its revision. All 3 authors approve of the final article. AN guarantees the scientific integrity of the study presented. AN takes responsibility for the paper as a whole., Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement., Publication dates: Available online April 23, 2008., Reprints not available from the authors.

The international community has committed to carbon neutrality, and Pittsburgh has responded. Long before the Paris Climate Accord proposed net-zero greenhouse gas emission, Pittsburgh had published two Climate Action plans, [...]

Background:Myasthenia gravis (MG) is an autoimmune disorder presenting with fluctuating, fatigable muscle weakness. Initial symptoms classically involve ocular and proximal limb muscles. Rarely, MG may onset with unusual features, so it can be misdiagnosed with other neuromuscular diseases. Objective:To describe unusual and atypical presentations of MG in a large cohort of patients, considering and discussing diagnostic difficulties and pitfalls. Methods:We report on 21 out of 508 MG patients, coming to our department in the last 27 years and presenting with atypical or unusual features. The diagnosis was achieved performing a careful clinical examination, a proper neurophysiological assessment, the neostigmine test, the AChR and MuSK antibodies assay and chest CT-scan. Results:Patients with atypical/unusual MG onset were the 4.4% of all MG patients population. We describe seven different clinical categories: asymmetric distal upper limbs weakness, foot drop, isolated triceps brachii weakness and foot drop, post exertional axial weakness with dropped head, acute facial dyplegia, limb-girdle MG and MG with sudden lower limbs weakness and recurrent falls. Conclusions:Atypical and unusual presentations may increase the risk to misdiagnose or delay MG diagnosis. Isolated limb-girdle presentation is the most frequent atypical form in our series.

A new example of restoration performed by the ancient Egyptian embalmers on a mummified body is reported. An imaging study of the mummy labelled 2343 in the Archaeological Museum of Naples has revealed the substitution of an artificial wooden ‘prosthesis’ for missing feet. The mummy probably dates to the Ptolemaic-early Roman Period, when other examples of prosthetics occur.

The natural headless mummy of a young man from the Basilica of Saint Domenico Maggiore in Naples (16th century) showed at autopsy a well-preserved fibrous liver with a nodular surface, suggesting a case of cirrhosis. Stereo and light microscope study confirmed this diagnosis. To identify the possible etiology of this cirrhosis, additional techniques currently used in pathology were performed. Hemochromatosis and alpha1-antitrypsin deficiency were investigated without results. Investigation regarding Wilson’s disease gave positive results, since the use of rhodamine staining, which is specific to detect the presence of copper in tissues, resulted in red-brown grains at light microscopy. The positive rhodamine test was invalidated by atomic absorption spectroscopy (AAS), which revealed normal copper levels in the tissues. These negative results and the clear and diffuse macronodularity of the liver suggest a case of post-necrotic cirrhosis.

The present case was investigated using non‐invasive methods in order to preserve the mummified body. Imaging techniques, routinely applied in contemporary diagnoses and in palaeopathology, were used. Digital radiography and computed tomography (CT), combined with more advanced techniques such as three‐dimensional reconstruction (3‐D CT) and virtual endoscopy (VE), permitted some unexpected evaluations during the study of a natural mummy belonging to a 16th century young woman. At external examination, the woman already showed an enormous enlargement of the left hemi‐abdomen. Laparoscopy, a recent surgical technique used in palaeopathology for the first time, made it possible to macroscopically observe the internal part of the abdomen and to obtain samples of internal mummified tissues for histology. All the results obtained by applying these different methodologies lead to the diagnosis of a case of puerperal death. Copyright © 1999 John Wiley & Sons, Ltd.

The autopsy of the mummy of Ferrante I of Aragon, King of Naples (1431–1494) revealed an adenocarcinoma extensively infiltrating the muscles of the small pelvis. A molecular study of neoplastic tissue observed a typical mutation of the K‐ras gene codon 12: the normal sequence GGT (glycine) was altered into GAT (aspartic acid). The recorded genetic change represents the most frequent mutation of the K‐ras gene in sporadic colorectal cancer and is characteristic of the effects of alkylating agents. Recent studies have focused the importance of some alkylating agents, such as the endogenous N‐nitroso compounds (NOC). Increased intake of red meat, such as beef, lamb or pork, induces a significant threefold increase of faecal NOC levels, with a range of exposure in faeces similar to that from tobacco‐specific NOC in cigarette smoke. The study of alimentary regimens of the Italian Renaissance courts, and in particular of the Aragonese court of Naples, produced evidence of very high red meat consumption, attested also by the palaeonutritional data. Therefore, the alimentary ‘environment’ of the Neapolitan court of the 15th century, with the abundance of natural endogenous alkylating agents, can well explain the K‐ras mutation causing the tumour that killed the Aragonese king over five centuries ago. Copyright © 1999 John Wiley & Sons, Ltd.

The autopsy of the mummy of Ferrante I of Aragon, King of Naples (1431–1494) revealed an adenocarcinoma extensively infiltrating the muscles of the small pelvis. A molecular study of neoplastic tissue observed a typical mutation of the K-ras gene codon 12: the normal sequence GGT (glycine) was altered into GAT (aspartic acid). The recorded genetic change represents the most frequent mutation of the K-ras gene in sporadic colorectal cancer and is characteristic of the effects of alkylating agents. Recent studies have focused the importance of some alkylating agents, such as the endogenous N-nitroso compounds (NOC). Increased intake of red meat, such as beef, lamb or pork, induces a significant threefold increase of faecal NOC levels, with a range of exposure in faeces similar to that from tobacco-specific NOC in cigarette smoke. The study of alimentary regimens of the Italian Renaissance courts, and in particular of the Aragonese court of Naples, produced evidence of very high red meat consumption, attested also by the palaeonutritional data. Therefore, the alimentary ‘environment’ of the Neapolitan court of the 15th century, with the abundance of natural endogenous alkylating agents, can well explain the K-ras mutation causing the tumour that killed the Aragonese king over five centuries ago. Copyright © 1999 John Wiley & Sons, Ltd.

The effects of gamna irradiation on cefuroxime and cefotaxime were studied. Degradation products and long-lived free radicals were investigated as a function of radiation dose. The formation of new impurities was evidenced by HPLC in both the compounds. A valuable increase of the pre-existent impurities, anti-isomer included, was found only in cefuroxime. ESR measurements put in evidence the presence of ganma radiation induced long-lived free radicals. Moreover, the influence of gamma irradiation on syn-anti isomerization was evaluated in comparison with the photoisomerization induced by ultraviolet light exposition on powder samples.

Differential Scanning Calorimetry was used to predict the physico-chemical compatibility between clenbuterol and some mucolytic drugs.Mixtures of clenbuterol and ambroxol, bromhexine, tiopronin, sobrerol, eprazinone and carbocysteine were examined. Using this method, only eprazinone and carbocysteine were found to be compatible with clenbuterol.

The influence of granulation process on the biopharmaceutical properties of experimental tablets has been studied, using phenyl butazone as a model substance. Four wet granulation procedures were compared. Moreover, in order to assess the influence of some surfactants, four different formulations were investigated

The effects of gamma and electron beam irradiation on cephradine were studied as a function of dose. In particular, degradation products and free radicals induced by radiation on samples with different moisture content were investigated. The influence of daylight on the kinetics of the degradation processes was also evaluated.

The in-vitro release of diltiazem from pharmaceutical equivalents of sustained release tablets, commercially available in Italy, was studied.The in-vitro release profiles were determined by means of different methods and apparatus. Paddle, basket, Poole, Diffutest and Stricker methods were compared.The absorption rates in artificial gastric and enteric juices by means of lipid barriers were calculated.Some preparations showed a diffusion mechanism, some a first-order release.The differences among the dissolution profiles of the formulations were enhanced with the Strieker method.

In order to improve the formulation of clenbuterol, the physico-chemical compatibility between this drug and various excipients commonly used in manufacturing of tablets, was studied by Differential Scanning Calorimetry (DSC).Using this method, clenbuterol was found to be compatible with talc, stearic acid, magnesium stearate and titanium dioxide, whereas an incompatibility was shown with maize starch, pregelatinized starch, sodium starch glicollate, polyvinylpyrrolidone, avicel PH 101 and lactose.

An investigation on the level and nature of particulate contamination in 36 large volume injectable solutions produced in Italy was performed, using Scanning Electron Microscopic (SEM) and X-ray microanalitic (EDS) techniques.Wide variability of the contaminant level, even within each individual batch, was observed.About 20% of the samples revealed a considerable amount of contaminants greater than 20 μm.Fibers of presumably textiles, cellulose or plastic materials were detected. Other particulate matter, from manifacturing and packaging processes, were observed.

Chronic Venous Disease (CVD) has a high prevalence in the western world. Varicose veins (VVs) are the main signs of this disease that is characterized by important pathological vessel wall changes. The aim of this study is to correlate the main histopathological abnormalities with related clinical issues of CVD.

Reports of cardiovascular diseases in ancient time are very rare since the material mainly consists of skeletal remains; therefore, these diagnoses can only be carried out indirectly, through the marks left on bones. Here we show a case of coarctation of the aorta diagnosed on bones. Aortic coarctation is a congenital disorder in which a portion of the aorta is narrowed to various extent. A collateral circulation system is enrolled to allow adequate compensation of the blood flow. Collateral vessels may become enlarged, producing a distinctive notching on the pleural surface of the ribs and on adjacent bones. Excavation of a sixth to fifth century B.C. Etruscan tomb revealed three funerary chambers (celle) housing 14 skeletal remains of adults. The ribs of one of the male skeleton showed “nail stroke” indentations. Detailed macroscopic examination enabled us to identify them as notching and led to the diagnosis of postductal aortic coarctation. Histological analysis of bone tissue from the notching areas excluded inflammatory and pathological erosive events, supporting the macroscopic diagnosis. The present paper is the first description of aortic coarctation in paleopathology.Reports of cardiovascular diseases in ancient time are very rare since the material mainly consists of skeletal remains; therefore, these diagnoses can only be carried out indirectly, through the marks left on bones. Here we show a case of coarctation of the aorta diagnosed on bones. Aortic coarctation is a congenital disorder in which a portion of the aorta is narrowed to various extent. A collateral circulation system is enrolled to allow adequate compensation of the blood flow. Collateral vessels may become enlarged, producing a distinctive notching on the pleural surface of the ribs and on adjacent bones. Excavation of a sixth to fifth century B.C. Etruscan tomb revealed three funerary chambers (celle) housing 14 skeletal remains of adults. The ribs of one of the male skeleton showed “nail stroke” indentations. Detailed macroscopic examination enabled us to identify them as notching and led to the diagnosis of postductal aortic coarctation. Histological analysis of bone tissue from the notching areas excluded inflammatory and pathological erosive events, supporting the macroscopic diagnosis. The present paper is the first description of aortic coarctation in paleopathology.

No abstract.