case report

Ethnobotanical tattooing of the gingiva: literature review and report of a case.: J Am Dent Assoc. 2007 Aug;138(8):1097-101 Authors: Brooks JK, Reynolds MA

BACKGROUND: Traditional gingival tattooing, practiced in Ethiopia and occasionally in other African and Middle Eastern nations, is performed for esthetic appeal or superstition, and it occasionally may be used as a homeopathic remedy for dental diseases. The authors provide a literature review and case report of this oral custom. CASE DESCRIPTION: A 54-year-old woman from Ethiopia reported that she had undergone tattooing of the maxillary gingiva six years previously for analgesic management of undisclosed oral disease. The gingiva was pierced with a needle, tipped with lantern soot and resin from the plant Datura stramonium (an herb that possesses potent anticholinergic tropane alkaloids and has demonstrated in vitro antimicrobial activity). However, the patient admitted that this procedure had provided no reduction in the pain. Clinical examination was significant for a pronounced blue pigmentation of the maxillary gingiva, generalized mild periodontitis and several carious lesions. CLINICAL IMPLICATIONS: Practitioners should ascertain whether gingival tattooing had been performed when patients manifest unusual oral pigmentation and be aware of its use in folk medicine for various oral conditions.

PMID: 17670877 [PubMed - indexed for MEDLINE]

Euphorbia lactea sap keratouveitis: case report and review of the literature.: Cornea. 2007 Jul;26(6):749-52 Authors: Merani R, Sa-Ngiampornpanit T, Kerdraon Y, Billson F, McClellan KA

PURPOSE: To describe a case of Euphorbia lactea sap keratouveitis and to review all reported cases of ocular toxicity caused by Euphorbia species. METHODS: Case report and review of literature. RESULTS: A 79-year-old woman presented 34 hours after she felt some sap of an E. lactea plant spray into her right eye. Visual acuity was counting fingers at 1 m. Examination revealed ciliary injection, 90% corneal epithelial defect, marked stromal edema with Descemet folds, and anterior-chamber flare with a 1-mm hypopyon. There was no vitreitis, and funduscopy was unremarkable. No foreign body was seen on B scan ultrasound or computed tomography scan of the orbits. Corneal scraping excluded bacterial and herpetic keratitis. Intensive topical antibiotic therapy was started with cephalothin 5% and gentamicin 0.9%, and the pupil was dilated with atropine. Topical steroids were started once the epithelial defect had healed. Examination 11 weeks after the injury revealed minimal subepithelial corneal haze and marked improvement in visual acuity. CONCLUSIONS: To the best of our knowledge, this is only the third reported case of E. lactea sap keratouveitis. The clinical course of E. lactea sap keratouveitis is compared with that reported for other Euphorbia species.

PMID: 17592331 [PubMed - indexed for MEDLINE]

Gynura root induces hepatic veno-occlusive disease: a case report and review of the literature.: World J Gastroenterol. 2007 Mar 14;13(10):1628-31 Authors: Dai N, Yu YC, Ren TH, Wu JG, Jiang Y, Shen LG, Zhang J

Gynura root has been used extensively in Chinese folk medicine and plays a role in promoting microcirculation and relieving pain. However, its hepatic toxicity should not be neglected. Recently, we admitted a 62-year old female who developed hepatic veno-occlusive disease (HVOD) after ingestion of Gynura root. Only a few articles on HVOD induced by Gynura root have been reported in the literature. It is suspected that pyrrolizidine alkaloids in Gynura root might be responsible for HVOD. In this paper, we report a case of HVOD and review the literature.

A case series of patients using medicinal marihuana for management of chronic pain under the Canadian Marihuana Medical Access Regulations.: J Pain Symptom Manage. 2006 Nov;32(5):497-501 Authors: Lynch ME, Young J, Clark AJ

The Canadian Marihuana Medical Access Regulations (MMAR) program allows Health Canada to grant access to marihuana for medical use to those who are suffering from grave and debilitating illnesses. This is a report on a case series of 30 patients followed at a tertiary care pain management center in Nova Scotia who have used medicinal marihuana for 1-5 years under the MMAR program. Patients completed a follow-up questionnaire containing demographic and dosing information, a series of 11-point numerical symptom relief rating scales, a side effect checklist, and a subjective measure of improvement in function. Doses of marihuana ranged from less than 1 to 5g per day via the smoked or oral route of administration. Ninety-three percent of patients reported moderate or greater pain relief. Side effects were reported by 76% of patients, the most common of which were increased appetite and a sense of well-being, weight gain, and slowed thoughts. Limitations of the study include self-selection bias, small size, and lack of a control group. The need for further study using controlled trials is discussed along with an overview of the MMAR program.

Treating threatened abortion with Chinese herbs: a case report.: Phytother Res. 2006 Oct;20(10):915-6 Authors: Qu F, Zhou J

In the report a patient who suffered from threatened abortion was successfully cured with Chinese herbs. After treatment, vaginal bleeding stopped and the aching sensation in the loins and prolapsing sensation in the abdomen disappeared. The gestational ring changed from a crescent moon shape to a normal shape.

Treatment of ADHD with French maritime pine bark extract, Pycnogenol.: Eur Child Adolesc Psychiatry. 2006 Sep;15(6):329-35 Authors: Trebatická J, Kopasová S, Hradecná Z, Cinovský K, Skodácek I, Suba J, Muchová J, Zitnanová I, Waczulíková I, Rohdewald P, Duracková Z

Attention Deficit/Hyperactivity Disorder (ADHD) is the most common psychiatric disorder in children. Pycnogenol, an extract from the bark of the French maritime pine, consisting of phenolic acids, catechin, taxifolin and procyanidins, has shown improvement of ADHD in case reports and in an open study. Aim of the present study was to evaluate the effect of Pycnogenol on ADHD symptoms. Sixty-one children were supplemented with 1 mg/kg/day Pycnogenol or placebo over a period of 4 weeks in a randomised, placebo-controlled, doubleblind study. Patients were examined at start of trial, 1 month after treatment and 1 month after end of treatment period by standard questionnaires: CAP (Child Attention Problems) teacher rating scale, Conner's Teacher Rating Scale (CTRS), the Conner's Parent Rating Scale (CPRS) and a modified Wechsler Intelligence Scale for children. Results show that 1-month Pycnogenol administration caused a significant reduction of hyperactivity, improves attention and visual-motoric coordination and concentration of children with ADHD. In the placebo group no positive effects were found. One month after termination of Pycnogenol administration a relapse of symptoms was noted. Our results point to an option to use Pycnogenol as a natural supplement to relieve ADHD symptoms of children.

Toxic Epidermal Necrolysis: Analysis of Clinical Course and SCORTEN-based Comparison of Mortality Rate and Treatment Modalities in Korean Patients.: Acta Derm Venereol. 2005;85(6):497-502 Authors: Kim KJ, Lee DP, Suh HS, Lee MW, Choi JH, Moon KC, Koh JK

Toxic epidermal necrolysis (TEN) is a rare, life-threatening, drug-induced cutaneous reaction. We herein report our experience regarding causes, clinical course, treatment and sequelae of TEN in Korean patients. In addition, we used the SCORTEN, a severity-of-illness score for TEN, to compare the predicted and actual mortality rates, and to evaluate the efficacy of treatment modalities. A retrospective study of 38 patients with TEN during a 13-year period (1990-2003) at the Asan Medical Center was performed. The mean involved body surface area was 49+/-17%. All except three cases were associated with medications, most commonly antibiotics, followed by non-steroidal anti-inflammatory drugs, acetaminophen and herbal remedies. Fourteen patients had a history of current infection, including upper respiratory infection, pneumonia and herpes simplex infection. The mean time from initial drug administration to the onset of TEN was 9.8+/-5.7 days. Twenty-one patients were treated with systemic corticosteroids. Fourteen received high dose intravenous immunoglobulin therapy. The actual mortality rate was 23.7% (9/38), not significantly different from the SCORTEN-predicted rate (25.5%, 9.699/38). Also based on SCORTEN, treatment with high dose intravenous immunoglobulin showed a trend to lower actual mortality than predicted mortality (standardized mortality ratio (SMR) = 0.425; 95% CI, 0.011-2.368), whereas corticosteroid therapy showed no such difference (SMR = 1.004; 95% CI, 0.369-2.187).

Muscle damage induced by black cohosh (Cimicifuga racemosa).: Phytomedicine. 2006 Jan; 13(1-2): 115-8 Minciullo PL, Saija A, Patafi M, Marotta G, Ferlazzo B, Gangemi S

Extracts of black cohosh (Cimicifuga racemosa) are commonly used for the treatment of symptoms associated with menopause. Adverse events with black cohosh are rare, mild and reversible. A few number of serious adverse events, including hepatic and circulatory conditions, have been also reported, but without a clear causality relationship. We report the case of a woman with severe asthenia and very high blood levels of creatine phosphokinase and lactate dehydrogenase. The patient referred to take a dietary supplement derived from black cohosh for ameliorating menopause vasomotor symptoms. To exclude a possible involvement of this product, the patient was suggested to discontinue this therapy. After suspicion the patient showed a progressive normalization of biochemical parameters and improvement of clinical symptoms. We can hypothesise a causative role for black cohosh in the muscle damage observed in this patient. Factors suggesting an association between black cohosh and the observed myopathy included the temporal relationship between use of herbal product and asthenia and the absence of other identified causative factors. Rechallenge with the suspected agent was inadvisable for ethic reasons because of the risk of a serious relapse. This is the first time that asthenia associated with high muscle enzymes serum levels by black cohosh has been reported. In our opinion, this report is of interest because of the widespread diffusion of use of black cohosh as an alternative medicine for relief from menopausal symptoms.

Allergic contact dermatitis induced by rosemary leaf extract in a cleansing gel.: J Dermatol. 2005 Aug;32(8):667-9 Authors: Inui S, Katayama I

We report a rare case of allergic contact dermatitis due to an extract of rosemary (Rosmarinus officinalis). A 23-year-old woman had begun to notice itchy erythema on her face around one month before presentation. She used various cosmetics and a cleansing gel containing rosemary leaf extract. From the patch test results, she reacted positively to the cleansing gel (1% in distilled water) and the rosemary leaf extract (0.1% in distilled water), one of its ingredients.

Hypertensive crisis associated with high dose soy isoflavone supplementation in a post-menopausal woman: a case report:

Background: Isoflavones are gaining popularity as alternatives to hormone replacement therapy. However, few guidelines exist to inform the public as to an appropriate dose. This case involves a postmenopausal woman who experienced a hypertensive crisis while consuming a high-dose isoflavone supplement as part of a research protocol.Case PresentationThe participant was part of a placebo-controlled crossover trial to investigate the potential synergism of the antioxidant activity of soy isoflavones and vitamin C. Upon entry into the study, this healthy, well-nourished, normotensive postmenopausal woman (51 years old), consumed the first of four randomly assigned treatments (500 mg vitamin C plus 5 mg/kg body weight soy isoflavones). During this treatment, the participant's systolic blood pressure spiked to a recorded 226/117 mmHg, necessitating medical intervention and discontinuation of study participation. Two plausible mechanisms for this hypertensive crisis are discussed.
Conclusion: Due to the availability and increasing popularity of soy supplements, practitioners should be aware of the potential side effects associated with their use. Practitioners counseling clients who are consuming soy isoflavone supplements should advise them that elevated blood pressure may be a potential side-effect to consider and monitor.