In Vitro and In Vivo evaluation of montmorillonite for paraquat poisoning

Abstract Evaluation of montmorillonite for paraquat by in vitro and in vivo test. In vitro test were evaluated by a batch test, taking the paraquat concentration, adsorbents, reaction environment and time as indices, the absorption rate was screened by orthogonal design. In vivo test was executed with rabbits. Group 1: 4 rabbits dosed with montmorillonite. Group 2: 8 rabbits dosed with 200 mg/kg paraquat. Group 3: 6 rabbits dosed with 200 mg/kg paraquat then gavage with montmorillonite 5 min later. Group 4: 6 rabbits dosed with 200 mg/kg paraquat then gavage with montmorillonite 30 min later. Blood paraquat concentration, serum cytokines, blood gas analysis and histopathology of lung were implemented. In vitro test found that all the four factors influence the absorption rate of paraquat (P < 0.05). In vitro test found that oral montmorillonite could change toxicokinetics parameters of paraquat (P < 0.05); decrease raised serum TGF-ß1 and HMGB1 (P < 0.05) and alleviate the histopathology damage of lung. Montmorillonite might exert its protective effects on paraquat induced damage

Advance of Forensic Research in Insulin Poisoning / 法医学杂志

Insulin as a common clinical hypoglycemic agent can effectively control serves to lower the concentration of blood glucose. However, insulin overdose can lead to death. In the whole fatal cases of insulin overdose, medical accident is the most common, followed by suicide. Though insulin homicide is extremely rare, it deserves great attention. Though there are some researches about insulin poisoning on forensic toxicology and pathology, it is still a difficult task in forensic practice. In this paper, the mechanism of death, pathological changes, detection methods and diagnose criteria of insulin overdose will be discussed in the view of forensic toxicology and pathology. We hope that this paper could enhance relative knowledges of insulin poisoning for medical examiners.

Histopathological characterization of experimentally induced cutaneous loxoscelism in rabbits inoculated with Loxosceles similis venom

Envenomation by Loxosceles bites is characterized by dermonecrotic and/or systemic features that lead to several clinical signs and symptoms called loxoscelism. Dermonecrotic lesions are preceded by thrombosis of the dermal plexus. Recent studies show that atheromatous plaque is prone to thrombosis due to endothelial cell apoptosis. To the best of our knowledge, there are no reports of microscopic dermal lesion and endothelial cell apoptosis induced by Loxosceles similis venom in the literature. Thus, the aim of the present study is to describe histological lesions induced by L. similis venom in rabbit skin and to elucidate whether apoptosis of endothelial cells is involved in the pathogenesis of loxoscelism. Forty male rabbits were split into two groups: the control group (intradermally injected with 50 µL of PBS) and the experimental group (intradermally injected with 0.5 µg of L. similis crude venom diluted in 50 µL of PBS). After 2, 4, 6 and 8 hours of injection, skin fragments were collected and processed for paraffin or methacrylate embedding. Sections of 5 µm thick were stained by HE, PAS or submitted to TUNEL reaction. Microscopically, severe edema, diffuse heterophilic inflammatory infiltrate, perivascular heterophilic infiltrate, thrombosis, fibrinoid necrosis of arteriolar wall and cutaneous muscle necrosis were observed. Two hours after venom injection, endothelial cells with apoptosis morphology were evidenced in the dermal plexus. Apoptosis was confirmed by TUNEL reaction. It seems that endothelial cell apoptosis and its consequent desquamation is an important factor that induces thrombosis and culminates in dermonecrosis, which is characteristic of cutaneous loxoscelism.

Aspectos clínico-patológicos do envenenamento botrópico experimental em equinos / Clinical and pathological aspects of the experimental poisoning by Bothrops snakes in horses

Estudou-se as alterações clínico-patológicas e laboratoriais em equinos, inoculados experimentalmente com a peçonha de Bothropoides jararaca, Bothrops jararacussu, Bothrops moojeni e Bothropoides neuwiedi, com a finalidade de fornecer subsídios para o diagnóstico do envenenamento pela picada dessas. Os venenos liofilizados foram diluídos em 1ml de solução fisiológica e administrados a seis equinos, por via subcutânea, nas doses de 0,5 e 1mg/kg (B. jararaca), 0,8 e 1,6mg/kg (B. jararacussu), 0,205mg/kg (B. moojeni) e 1mg/kg (B. neuwiedi). Todos os equinos, menos os que receberam o veneno de B. jararacussu, morreram Os sinais clínicos iniciaram-se entre 8min e 2h10min após a inoculação. O período de evolução variou, nos quatro casos de êxito letal, de 24h41min a 70h41min, e nos dois equinos que se recuperaram foi de 16 dias. O quadro clínico, independente do tipo de veneno e das doses, caracterizou-se por aumento de volume no local da inoculação, arrastar da pinça do membro inoculado no solo, inquietação, apatia, diminuição da resposta aos estímulos externos, mucosas pálidas e hemorragias. Os exames laboratoriais revelaram anemia normocítica normocrômica com progressiva diminuição no número de hemácias, da hemoglobina e do hematócrito, e leucocitose por neutrofilia. Houve aumento de alamina aminotransferase, creatinaquinase, dehidrogenase láctica, ureia e glicose, bem como aumento do tempo de ativação da protrombina e do tempo de tromboplastina parcial ativada. Os achados de necropsia foram extensas hemorragias no tecido subcutâneo, com presença de sangue não coagulado e em boa parte associadas a edema (edema hemorrágico), que se estendia desde o local da inoculação até as regiões cervical, torácica, escapular e membro. Na periferia das áreas hemorrágicas havia predominantemente edema gelatinoso. Havia ainda presença de grande quantidade de líquido sanguinolento nas cavidades torácica, pericárdica e abdominal. Não foram encontradas alterações histológicas significativas.(AU)

The clinical and pathological alterations in horses, experimentally inoculated with Bothropoides jararaca, Bothrops jararacussu, Bothrops moojeni and Bothropoides neuwiedi poisons, were studied with the purpose to supply subsidies for the diagnosis of the poisoning. The liofilized poisons were diluted in 1ml of physiologic solution and subcutaneously administered to six horses, at doses of 0.5 and 1mg/kg (B. jararaca), 0.8 and 1.6mg/kg (B. jararacussu), 0.205mg/kg (B. moojeni) and 1mg/kg (B. neuwiedi). All horses, less those that received the poison of B. jararacussu, died The clinical signs began between 8min and 2h10min after the inoculation. The clinical course varied, in the four cases of lethal exit, from 24h41min to 70h41min, and was 16 days in the two horses that recovered,. The clinical picture, independent of the poison type and doses, was characterized by tumefaction at the site of inoculation, dragging on the ground with the hooves of the inoculated leg, inquietude, apathy, decrease of reaction to external stimuli, pale mucous membranes and hemorrhages. Laboratory exams revealed normocytic normochrômic anemia with progressive decrease in the number of erythrocytes, of hemoglobin and of the hematocrit, and leucocytosis due to neutrophilia. There was increase of alamina aminotransferase, creatinaquinase, lactic dehydrogenase, ureia and glucose, as well increase of the time of activation of protrombin and partial tromboplastina. At postmortem examination, the main findings were extensive hemorrhagic areas in the subcutaneous tissue, with the presence of non-coagulated blood, to a large degree associataed with edema (hemorragic edema), which extended from the inoculation site of the venom to the cervical, thoraxic and scapular region, and to the leg. In the periphery of the hemorragic areas existed gelatinous edema. There were great amounts of sanguinary liquid in the thoracic, pericardic and abdominal cavities. No significant histological alterations were found.(AU)

Intoxicação experimental aguda por samambaia (Pteridium aquilinum) em bovinos / Experimental acute poisoning by bracken fern (Pteridium aquilinum) in cattle

Este experimento foi delineado para investigar os seguintes pontos em relação à intoxicação aguda por samambaia (Pteridium aquilinum) em bovinos: 1) a intensidade da trombocitopenia em diferentes momentos da intoxicação e sua relação com possíveis déficits na hemostasia secundária, 2) a relação da neutropenia com as manifestações morfológicas de septicemia ocasionalmente observadas na necropsia, e 3) o mecanismo da anemia e sua relação com a perda de sangue, a vida média eritróide e a evolução da doença. As hastes superiores mais verdes de P. aquilinum foram administradas a quatro bovinos sem raça definida, com idade média de 1,5 ano e pesos entre 190-215 kg. Um bovino de idade e peso semelhantes foi usado como controle e, exceto por não ter recebido P. aquilinum, foi mantido nas mesmas condições que os outros quatro. Os quatro bovinos que receberam a planta morreram com quadro característico da intoxicação aguda por samambaia após receberem durante 53-58 dias, doses diárias de 8,0, 8,6, 10,2 e 10,6g/kg de peso corporal, que totalizaram, ao final do experimento, respectivamente, 112,7, 107,6, 85,7, 90,15 kg da planta, o que corresponde, respectivamente, a 59,3 por cento, 63,3 por cento, 47,4 por cento, 47,5 por cento da planta em relação ao peso dos bovinos. A doença caracterizou-se por febre de até 42,5 graus C e diversos graus de hemorragias observadas clinicamente, na necropsia e na histopatologia. A morte ocorria 6-7 dias após o início do quadro febril. As alterações hematológicas revelaram trombocitopenia e neutropenia acentuadas. Em dois dos quatro bovinos havia anemia leve. Não houve variações significativas nos tempos de coagulação dos bovinos intoxicados, quando avaliados os fatores de coagulação (secundária), excluindo-se assim a possibilidade da participação de distúrbios da hemostasia secundária na patogênese das hemorragias nessa intoxicação. A determinação dos produtos da degradação da fibrina no soro revelou dados conflitantes...

This experiment was design to address the following points in relation to the acute poisoning by bracken fern (Pteridium aquilinum) in cattle: 1) the severity of the thrombocytopenia in different stages of the intoxication and its relationship to possible deficits in the secondary hemostasis, 2) the relationship between neutropenia and the morphological signs of septicemia occasionally found at necropsy, and 3) the mechanism of anemia and its relationship with blood loss, medium life of erythrocytes and the progress of the disease. The fresh green upper parts of P. aquilinum were fed to four mixed breed calves with average age of 18 months and weights ranging from 190 to 215 kg. A calf of similar age and weight was kept together with the other four under the same conditions, except for the ingestion of P. aquilinum. The four fern-fed calves died with typical features of acute bracken fern poisoning after being fed with the plant for 53-58 days daily doses of 8.0, 8.6, 10.2, and 10.6g/kg body weight totaling at the end of the experiment, respectively, 59.3 percent, 63.3 percent, 47.4 percent, and 47.5 percent of bracken fern in relation to their body weight. The disease was characterized by fever up to 42.5 grades C and varying degrees of hemorrhages observed clinically, at necropsy and on histological examination. Death occurred 6-7 days after the onset of fever. The hematological changes consisted mainly of marked thrombocytopenia and neutropenia. Two of the four affected calves had mild anemia. The deficits in secondary hemostasis were mild in each case. There were no significant changes thus permitting to rule out the role of secondary hemostasis in the pathogenesis of the hemorrhages in the bracken fern poisoning. The measurement of fibrin degradation products in the serum showed conflicting results and did no allow for a solid conclusion regarding the role of disseminated intravascular coagulation in the pathogenesis of the hemorrhages...

Prevalencia de la intoxicación mortal por suicidios casuística de los últimos años / Prevalence of fatal poisoning suicide cases in recent years

Conocer el panorama de las muertes intencionales por intoxicación, ingresados en el Hospital Central San Cristóbal (HCSC) entre 2000 a 2004. La recolección de información realizada para el presente análisis comprendió los datos de notificación del material constituido por historias médicas del HCSC siendo el método utilizado para la recolección de datos a través de fichas individuales. La letalidad por intoxicaciones voluntarias se calculó como el número de muertes en relación con el total de muertes por intoxicaciones. Estadísticamente se utilizó revisión y análisis retrospectivo de los expedientes, así como investigación bibliográfica actualizada sobre el tema. Las variables analizadas fueron: edad, sexo, año, sustancia, vía de exposición. Fueron estudiados 110 casos de adultos muertos por intoxicación de los cuales 77 (70 por ciento) fueron de manera intencional, de esta últimas cifras(total), 70 por ciento fueron mujeres en comparación al sexo masculino, la edad predominante fue de 18 a 38 años con una media de 28. El análisis temporal indica tendencia al incremento en el número de casos en los últimos años, siendo para el año 2004 67 por ciento en comparación a los años 2001-2003, resultando consistentemente mayor por el plaguicida Organofosforados, ocupando el primer lugar con un 78 por ciento, seguido de otros plaguicidas 10 por ciento, medicamentos 7 por ciento y otras sustancias 5 por ciento la vía de exposición fue la oral en el 85 por ciento. Este estudio nos permite observar las tendencias de las muertes intencionales por intoxicación y mejorar el conocimiento de las mismas, adecuar normas de atención y establecer pautas de prevención. Las intoxicaciones en ciudades de alta densidad poblacional por exposición intencional son permanentes. Las sustancias tóxicas que causan el mayor número de muertes por intoxicación son los plaguicidas del grupo de los Organofosforados. La población desconoce la magnitud de los efectos qque puede generar.

Aspectos clínico-patológicos e laboratoriais do envenenamento crotálico experimental em bovinos / Clinical and pathological aspects of experimental Crotalus poisoning in cattle

Reproduziu-se experimentalmente o envenenamento crotálico, através da inoculação, por via subcutânea, do veneno de Crotalus durissus terrificus (cascavel sul-americana) em dez bovinos mestiços. Dois animais foram utilizados como controle. O bovino que recebeu dose de 0,03mg/kg de peso corporal, morreu 7h40min após a inoculação. A dose de 0,015mg/kg causou a morte em quatro de sete bovinos inoculados, enquanto os dois animais que receberam 0,0075mg/kg adoeceram discretamente e se recuperaram. Os sintomas tiveram início entre 1h30min e 13h45min após a inoculação. A evolução oscilou entre 5h25min e 45h para os animais que morreram e entre 33h15min e 17 dias entre os animais que se recuperaram. Os principais sinais nervosos observados foram diminuição da resposta aos estímulos externos, reflexos hipotônicos, arrastar dos cascos no solo, aparente apatia, paralisia do globo ocular e da língua, decúbito esternal e lateral. Verificaram-se também adipsia e, por vezes, petéquias nas mucosas vaginal e conjuntival. Houve discreto a moderado aumento do tempo de sangramento e moderado aumento do tempo de tromboplastina parcial ativada. Houve moderada leucocitose com neutrofilia, linfopenia relativa, eosinopenia, monocitose e discreto aumento do número de bastões. Foi evidenciado significativo aumento dos níveis séricos de creatinaquinase, contudo, não foram observadas alterações significativas através da urinálise. À necropsia constataram-se edema quase imperceptível no local da inoculação, discretas petéquias e sufusões no epicárdio, omento, vesícula biliar e mucosa da bexiga em alguns dos animais envenenados experimentalmente. Os exames histopatológicos revelaram necrose (hialinização) de grupos de miócitos ou em miócitos isolados em dez diferentes músculos esqueléticos examinados, próximos ou distantes do local de inoculação em todos os animais necropsiados. Concluí-se que o envenenamento por Crotalus Sul-americanas em bovinos não cursa com mioglobinúria...

Crotalus poisoning was experimentally reproduced by subcutaneous inoculation of Crotalus durissus terrificus (South American rattlesnake) venom into 10 clinically healthy mixed bred 12 to 36-month-old cattle, weighing 125 to 449 kg. Two animals were used as controls. The animal that received a dose of 0.03mg/kg body weight died 7h40min after inoculation. A 0.015mg/kg dose provoked death in 4 out of 7 young oxen. Two animals given 0.0075mg/kg became slightly sick and recovered. Onset of symptoms occurred from 1h30min to 13h45min after inoculation. The clinical course varied from 5h25min to 45h for animals that died, and from 33h15min to 17 days for animals that recovered. The main nervous signs observed were diminished response to external stimuli, hypotonic reflexes, dragging of the hooves, apathy, difficulties in moving around obstacles, ocular globe paralysis, lateral and sternal decubitus, and tongue paralysis. Adipsia and sometimes petechiae in the conjunctival and vaginal mucosa were observed. A slight to moderate increase in bleeding time was noted in 6 animals, and a moderate increase in partial thromboplastin time was found in 7 others. Moderate leukocytosis with neutrophilia, relative lymphopenia, eosinopenia, and monocytosis was found. There was a significant increase in creatine kinase serum levels of a ten-fold order. No significant alterations were revealed by urinalysis. Necropsy revealed minimal edema at the inoculation site, few petechiae and equimoses in the epicardium, omentum, biliary vesicle and bladder mucosa of some animals. Histopathological examination revealed necrosis (hyalinization) of groups or isolated myocytes in different muscles examined, both near and far from the inoculation site, in all animals. The diagnosis of Crotalus poisoning and its differentiation from diseases causing paralysis and muscular necrosis in cattle in Brazil are discussed.

Acute necrotizing pancreatitis and postmortem autolysis of pancreas / 法医学杂志

OBJECTIVE@#To compare the pathomorphologic changes between the pancreas in acute necrotizing pancreatitis (ANP) and that in acute deaths of rats (within 48 hours) so as to find the distinctions.@*METHODS@#The animal models of ANP and other acute deaths (electroshock, mechanic asphyxia/strangle, and acute poisoning with tetramine) were established according to the criteria. Half-quantitative grading and image quantitative analysis methods were employed to observe the gross and microscopic changes of the pancreases.@*RESULTS@#Three features including inflammation infiltrate, fat necrosis and calcium deposit in the ANP group were considerably different from that in other acutely died rat group (P<0.05).@*CONCLUSION@#Inflammation infiltrate, fat necrosis and calcium deposit are the most important pathologic features found in ANP by common light microscope, distinguishing ANP from postmortem pancreatic autolysis.

Assessment of injuries caused by diethyl sulfate poisoning / 法医学杂志

OBJECTIVE@#To develop criteria to assess injuries due to diethyl sulfate poisoning.@*METHODS@#Patients were evaluated with respect to their toxic status and outcomes, in comparison to typical cases.@*RESULTS@#Among 44 poisoned patients, 4 patients were classified as major injuries, 4 person as minor injuries, and the rest of 36 patients were classified as not poisoned according to poisoning diagnostic criteria by No.GBZ40-2002 "Diagnostic Criteria of Occupational Acute Diethyl Sulfate Poisoning".@*CONCLUSION@#In assessment of the injuries caused by diethyl sulfate poisoning, one should follow diagnostic criteria set by National Occupational Acute Poisoning due to Chemicals and Drugs and "Criteria for Assessment of Human Body Injury."

Experimental envenomation with Crotalus durissus terrificus venom in dogs treated with antiophidic serum - part II: laboratory aspects, electrocardiogram and histopathology

The present work shows laboratory aspects, electrocardiogram and histopathology results during experimental envenomation by Crotalus durissus terrificus in dogs treated with antiophidic serum. Twenty-one dogs were divided into three groups of seven animals each. Group I received 1mg/kg venom (sc); Group II received 1mg/kg venom (sc), 50mg antiophidic serum (iv) and fluid therapy including 0.9 percent NaCl solution (iv); and Group III received 1mg/kg venom (sc), 50mg antiophidic serum (iv) and fluid therapy including 0.9 percent NaCl solution containing sodium bicarbonate diluted to the dose of 4mEq/kg. Urinalysis showed brown urine, proteinuria, occult blood and myoglobinuria. Respiratory acidosis and hypotension were also observed. At the venom inoculation site, there was discreet edema, popliteal lymph node response, musculature presenting whitish areas and necrotic myositis with myoregenerative activity. There was not evidence of electrocardiographical and biochemical alterations.

Study on ultra-structural pathological changes of rats poisoned by tetramine / 法医学杂志

OBJECTIVE@#To observe ultra-structural pathological changes of materiality viscera of rats poisoned by different dose of tetramine and to study the toxic mechanism.@*METHODS@#Acute and subacute tetramine toxicity models were made by oral administration with different dose of tetramine. Brain, heart, liver, spleen and kidney were extracted and observed by electromicroscopic examination.@*RESULTS@#The injuries of brain cells, cardiocytes and liver cells were induced by different dose of tetramine. These were not obviously different of the injuries of the kindy cells and spleen cells of rats poisoned by different dose of tetramine. Ultra-structural pathological changes were abserved including mitochondria slight swelling and neurolemma's array turbulence in the brain cells, mitochondria swelling or abolish and rupture of muscle fiber in the heart cells, mitochondria swelling and the glycogen decreased in the liver cells.@*CONCLUSION@#The toxic target organs of tetramine are the heart, brain and liver.

The study of status and advances on tetramine poisoning / 法医学杂志

Tetramethylenedisulphotetramine(TETS) is virulent rodenticides which was strictly forbidden to use in China. Poison dose of TETS is very little, LD50 in rats in 0.1 mg/kg. Manifestations and signs of TETS poisoning are showed in 5 min. The long dated effect of poisoning is extremely strict. Mamy studys on TETS are restricted on the treatment of TETS poisoning, while that of poisoning mechanism is very few. This paper reviewed TETS poisoning mechanism, pathological changes and research advances.

Principales factores relacionados con la intoxicación por celphos, pastilla del amor y la asistencia de urgencia. Hospital Asunción, Juigalpa. enero - junio 2003 / Main factors related with the intoxication for celphos, pill of the love and the attendance of urgency. Hospital Asunción, Juigalpa. January - June 2003

El presente trabajo titulado principales factores relacionados con la intoxicación por CELPHOS 56, pastilla del amor y la asistencia de enfermería de urgencia. Fue realizado en pacientes que ingresaron a la sala de emergencia del Hospital Asunción, Juigalpa, Chontales enero- junio 2003. El universo estuvo formado por 21 pacientes que fueron ingresados en emergencia del Hospital Asunción; con diagnóstico de intoxicación por órganos fosforados. De estos se tomaron 10 para entrevista durante el período de estudio. Para recolectar la información se utilizó una guía de revisión de expediente, una guía de observación dirigida al personal de enfermeria y una guía de entrevista al paciente. Las principales conclusiones del estudio fueron: El sexo más afectado fue el masculino y el rango de edad que sufrió más intoxicaciones es de 15- 20 años. Según las religiones la más vulnerables es la católica, relacionada con el estado civil fue acompañado. En cuanto a los factores de riesgo se realiza el lavado de manos y en segundo lugar uso de botas. Las principales recomendaciones del estudio fueron: El MINSA a través del SILAIS Chontales se capacito al personal de salud para que esté preparado para enfrentar estos casos y evitar muertes de personas afectadas, directa e indirectamente por este tipo de insecticida...

Apoptosis in mouse after tetramine poisoning / 法医学杂志

OBJECTIVE@#To observe pathological changes and apoptosis in mouse brain, hart, liver and kidney after tetramine poisoning, and to provide some references for forensic identification.@*METHODS@#An experimental model of mouse tetramine poisoning was found, and the technology of apoptosis detection was used. The staining results were analyzed by computer image analysis competitive system.@*RESULTS@#(1) Quantities of apoptosis in brain, hart, liver and kidney in chronic poisoning groups are many more than in acute poisoning groups. As in same organs, Quantities of apoptosis are different after different poisoning time. In addition, the peak-time of apoptosis is not same in different organs. (2) Poison analysis showed that, all organic samples from acute poisoning groups were positive, while that from chronic poisoning groups are negative.@*CONCLUSION@#Chronic tetramine poisoning can not be detective by clinic or poison analysis while can be found changes in apoptosis, which indicate that small amount and chronic poisoning still affects the body.

Intoxicación por guayacol (metoxifenol) / Guayacol (metoxifenol) intoxication

Presentamos el caso de una mujer joven que sufrió intoxicación por guayacol (metoxifenol), cuyo desenlace fue fatal. Presentó alteraciones neurológicas, hemodinámicas (choque), respiratorias (hipoxemia refractaria), metabólicas (acidosis metabólica grave), renales (necrosis tubular aguda), digestivas y hematológicas. Motivo de defunción: Edema agudo pulmonar grave secundario a congestión visceral generalizadas. Todas las alteraciones antes mencionadas correlacionaron con lo evidenciado en los exámenes de laboratorio, electrocardiograma y necropsia. Tal vez este sea el primer caso de intoxicación por guayacol (metoxifenol) registrado en el mundo

Loxoscelismo / Loxoscelism

El envenenamiento por mordedura de la araña Loxosceles reclusa, es un padecimiento que causa lesiones necróticas en piel y tejido celular subcutáneo, y manifestaciones sistémicas que pueden ser leves como hemólisis mínima hasta coagulación intravascular diseminada. La pérdida de la extremidad es frecuente cuando no se logra detener la evolución de las lesiones dérmicas y el uso de Dapsone, aunque controversial, ha resultado de utilidad para el manejo de éstas. En este artículo se presenta la experiencia en el Servicio de Angíología del Hospital de Especialidades Centro Médico ®La Raza¼ en el manejo de esta tan especial patología que conlleva en muchas ocasiones a diagnósticos equívocos y por ende a manejos inadecuados

Arsenicismo crónico y cáncer de piel / Chronic arsenic poisoning and skin cancer

La intoxicación crónica con arsénico es una causa importante de cáncer de piel en nuestro país. Se presenta un grupo de siete pacientes, y se describen los aspectos clínicos y terapeúticos de estas neoplasias

Intoxicación aguda por compuestos organofosforados

Se hizo el estudio de 207 pacientes intoxicados por organofosforados durante el periodo 1993-95, en el Hospital Honorio Delgado de Arequipa. Se encontró un incremento en el número de hospitalizaciones por esta patología (0,39 por ciento) y un número creciente de casos cada año. La edad de la mayor incidencia fluctuo entre la 2a y 3a décadas de la vida (74,87 por ciento), predominando el sexo femenino con el 60,32 por ciento; la mayoría de casos procedentes de distritos urbanos de la ciudad (64,23 por ciento), la ocupación principal fue ser estudiantes (42,02 por ciento), con un nivel de instrucción entre secundaria y superior (66,17 por ciento). Solteros en su mayoría (61,38 por ciento). La causa más frecuente de intoxicación fue la suicida con el 71,01 por ciento. El 87,74 por ciento de los envenenamientos se produjo luego de una discusión familiar o con la pareja. Aunque el 89,91 por ciento de estos pacientes no manifestó una psicopatología evidente. El 68,7 por ciento de los casos de intoxicación suicida corresponden a mujeres, de las cuales un 88,11 por ciento se encuentran entre la 2a y 3a décadas de la vida. En Parathión fue el responsable de mayor número de intoxicaciones (28,01 por ciento), la vía de intoxicación más frecuente fue la oral (78,74 por ciento). Los vómitos, el dolor abdominal y el aumento de secreciones fueron los síntomas iniciales más frecuentes. La llegada de los pacientes al hospital se produjo generalmente dentro de las tres primeras horas posteriores a la intoxicación (55,54 por ciento). Las fasciculaciones, el aumento de secreciones y la miosis fueron los signos más frecuentes hallados en emergencia. La mayor parte de intoxicaciones fue de tipo moderado o grave (67,62 por ciento). Todos los casos se manifestaron con un Síndrome Colinérgico Agudo, aunque hubo un 2,41 por ciento de pacientes con un cuadro compatible con un Síndrome Intermedio. Las fasciculaciones, el dolor abdominal y la cefalia fueron las manifestaciones más frecuentes durante la hospitalización. En el 66,66 por ciento de los caos no se aplicó ningún tratamiento extrahospitalario. El sulfato de atropina se aplicó en todos los casos. La intoxicación atropínica fue la complicación más frecuente (67,62 por ciento). Las dosis de atropina mayormente empleadas fluctuaron entre 1 y 20 mg (31,87 por ciento). La mayoría de pacientes tubo una evolución favorable (90,82 por ciento) y la letalidad fue del orden de 4,83 por ciento.

Intoxicaciones agudas en pediatría: Hospital Central Universitario "Dr. Antonio María Pineda" Enero 1991-Enero 1992 / Acute poisoning in pediatry that had been attended at \"Dr Antonio María Pineda\" University Central Hospital. January 1991-January 1992

Se estudiaron 2.200 casos de intoxicación agudas que consultaron a la Emergencia Pediátrica del Hospital Central Universitario "Dr. Antonio María Pineda". La intoxicación más frecuente fue la medicamentosa, seguida de los agentes de uso doméstico. La circunstancia predominante fue la accidental. Los lactantes representaron el grupo etario más afectado; en general prodedían del medio urbano. Los escolares estuvieron más afectados por emponzoñamiento ofídico y escorpiónico y procedían generalmente del medio rural. El sexo más afectado fue el masculino. Ciento cuarenta y cuatro (144) pacientes presentaron manifestaciones clínicas severas. El 68,8 por ciento de los casos fueron tratados ambulatoriamente. Se registró una mortalidad del 0,3 por ciento

Intoxicaciónes agudas en el Servicio de Urgencias del Hospital Carlos Andrade Marín, 1985-1990

Las intoxicaciones con distintos productos tóxicos se ha convertido en una patología habitual en los servicios de urgencias de nuestros hospitales. Este trabajo es un estudio de las intoxicaciones atendidas en el sercicio de urgencias del HCAM durante 1985-1990. Estudio observacional. longuitudinal, prospectivo y descriptivo simple de cuasa a efecto. Se encontró 754 pacientes intoxicados que constituyen el 0.2 por ciento del total de pacientes ingresados en urgencias, de los cuales el 65.9 por ciento corresponden a pacientes entre los 15 y 35 años, 70 por ciento son varones, 71 por ciento casados, el grupo poblacional más afectado son los obreros en el 34 por ciento y profesionales en el 20 por ciento, 80 por ciento provienen de áreas urbanas. la causas más frecuentes de intoxicación son alcoholismo 47.3 por ciento; alimentaria 35 por ciento; y en mayor porcentaje farmacológicos: analgésicos, benzodiacepinas, barbitúricos, antidepresivos triciclicos, tónicos cardíacos. el intervalo entre intoxicación y asistencia fue de 5 a 8 horas en el 46.5 por ciento y más de 8 horas un 31 por ciento. La mayoría fue tratado su ingreso con lavado gástrico y catárticos, un porcentaje de pacientes intoxicados por fósforo blanco recibió plasmaféresis. Las intoxicaciones en nuestro medio son de alta prevalencia, y el diagnóstico y tratamiento en forma oportuna salvarán la vida de muchos pacientes.