Tardily accelerated neurologic deterioration in two-step thallium intoxication.

Thallium intoxication was reported in cases with accidental ingestion, suicide attempt, and criminal adulteration. Reported cases were mostly one-time ingestion, therefore, the clinical course of divisional ingestion has not been fully known. Here, we report a case with two-step thallium intoxication manifesting as tardily accelerated neurologic deterioration. A 16-year-old adolescent was cryptically poisoned with thallium sulfate twice at an interval of 52days. After the first ingestion, neurologic symptoms including visual loss, myalgia, and weakness in legs developed about 40days after the development of acute gastrointestinal symptoms and alopecia. After the second ingestion, neurologic symptoms deteriorated rapidly and severely without gastrointestinal or cutaneous symptoms. Brain magnetic resonance imaging exhibited bilateral optic nerve atrophy. Nerve conduction studies revealed severe peripheral neuropathies in legs. Thallium intoxication was confirmed by an increase in urine thallium egestion. Most of the neurologic manifestations ameliorated in two years, but the visual loss persisted. The source of thallium ingestion was unraveled afterward because a murder suspect in another homicidal assault confessed the forepast adulteration. This discriminating clinical course may be attributable to the cumulative neurotoxicity due to the longer washout-time of thallium in the nervous system than other organs. It is noteworthy that the divisional thallium intoxication may manifest as progressive optic and peripheral neuropathy without gastrointestinal or cutaneous symptoms.

Heavy metals exposure and hearing loss in US adolescents.

INTRODUCTION: Hearing loss is common and, in young persons, can compromise social development and educational achievement. Exposure to heavy metals has been proposed as an important risk factor for hearing loss. METHODS: We evaluated the cross-sectional associations between blood lead, blood mercury, and urinary cadmium and arsenic levels and audiometrically determined hearing loss in participants aged 12 to 19 years in the 2005-2008 National Health and Nutrition Examination Survey after accounting for the complex survey design. There were 2535 individuals available for analysis of blood lead and mercury levels, 878 for urinary cadmium levels, and 875 for urinary arsenic levels. Multivariate logistic regression was used to calculate adjusted odds ratios (ORs) and 95% CIs. RESULTS: A blood lead level greater than or equal to 2 µg/dL (to convert to micromoles per liter, multiply by 0.0483) compared with less than 1 µg/dL was associated with increased odds of high-frequency hearing loss (OR, 2.22; 95% CI, 1.39-3.56). Individuals in the highest quartile of urinary cadmium levels had significantly higher odds of low-frequency hearing loss than those in the lowest quartile (OR, 3.08; 95% CI, 1.02-9.25). There was no overall association between quartiles of blood mercury or urinary arsenic levels and hearing loss. CONCLUSION: Blood lead levels well below the current recommended action level are associated with substantially increased odds of high-frequency hearing loss.

[Rapid analysis of toxic heavy metals in foods for emergency response to health crisis].

A simple and rapid method for determination of intentional contamination with heavy metals in foods using inductively coupled plasma-atomic emission spectroscopy (ICP-AES) has been developed. The heavy metals were extracted with sulfuric acid in a disposable tube using a homogenizer. The extract was diluted with 1% HNO(3) solution and analyzed with ICP-AES. Recovery tests of 9 metals, As, Cd, Cr, Hg, Mn, Pb, Sb, Sn, and Tl, from 12 foods were performed, and gave acceptable recovery (71-107%) with low relative standard deviation (1-11%). The time required for conversion of 12 samples to test solutions was approximately 2 hr. This method could be useful for identification of heavy metals involved in food poisoning cases.

Lead and mercury exposures: interpretation and action.

Lead and mercury are naturally occurring elements in the earth's crust and are common environmental contaminants. Because people concerned about possible exposures to these elements often seek advice from their physicians, clinicians need to be aware of the signs and symptoms of lead and mercury poisoning, how to investigate a possible exposure and when intervention is necessary. We describe 3 cases of patients who presented to an occupational medicine specialist with concerns of heavy metal toxicity. We use these cases to illustrate some of the issues surrounding the investigation of possible lead and mercury exposures. We review the common sources of exposure, the signs and symptoms of lead and mercury poisoning and the appropriate use of chelation therapy. There is a need for a clear and consistent guide to help clinicians interpret laboratory investigations. We offer such a guide, with information about population norms, lead and mercury levels that suggest exposure beyond that seen in the general population and levels that warrant referral for advice about clinical management.

Time-resolved monitoring of heavy-metal intoxication in single hair by laser ablation ICP-DRCMS.

The potential of laser ablation inductively coupled plasma mass spectrometry for the time-resolved analysis of heavy-metal intoxication in human bodies by analysis of hair is demonstrated. As application, we analyzed forensic samples from one individual after Hg intake and from one treated with a Pt-containing cytostatic remedy. Single hairs were analyzed from the hair root to the tip by laser ablation ICP-MS with a spatial resolution of 20 mum (corresponding to approx. 2 h growth of the hair). Sulfur was used as internal standard and was analyzed by using oxygen as reaction gas in the dynamic reaction cell of the ICP-DRCMS. The detection limits for Hg and Pt were found to be 0.3 microg g(-1) and 0.5 ng g(-1), respectively. Standard uncertainties for the quantification results were 10% for Hg and approximately 15 % for Pt. The analyzed hair samples reflected the forensic evidence in both cases. A significant increase of Hg concentration, by a factor of 50, at the time of HgO administration could be shown, and variation of Pt in the hair strands could be used to monitor the time and relative amount of Pt intake by the patient. The investigations also revealed that the concentrations in the outer and the inner parts of the hair varied similarly with time, even though the concentration in the core of the hair is approximately 0.25 that at the surface for both Pt and Hg.

[Nervous system involvement in three children poisoned with thallium]. / Zajecie ukladu nerwowego u trojga dzieci zatrutych talem.

Three children, aged 5, 10 and 16 years, poisoned with thallium were hospitalized. Two of them suffered from sensory-motor and third from sensory polyneuropathy and additionally in the youngest child severe encephalopathy was observed. The correlations between serum and urine thallium levels and the severity of the symptoms in the course of the disease were positive. The most severe symptoms and the highest thallium level were observed in the youngest child.

Methodological problems in the neuropsychological assessment of effects of exposure to welding fumes and manganese.

Recently, Kaiser (2003) raised concerns over the increase in brain damage claims reportedly due to exposure to welding fumes. In the present article, we discuss methodological problems in conducting neuropsychological research on the effects of welding exposure, using a recent paper by Bowler et al. (2003) as an example to illustrate problems common in the neurotoxicity literature. Our analysis highlights difficulties in conducting such quasi-experimental investigations, including subject selection bias, litigation effects on symptom report and neuropsychological test performance, response bias, and scientifically inadequate casual reasoning.

Application of laser-induced breakdown spectroscopy technique to hair tissue mineral analysis.

The concentration of the main minerals present in human hair is measured on several subjects by Calibration-Free Laser-Induced Breakdown Spectroscopy (CF-LIBS) and compared with the results obtained through a commercial analytical laboratory. The possibility of using CF-LIBS for mineral analysis in hair is discussed, as well as its feasibility for the fast and inexpensive determination of the occurrence of heavy-metal poisoning in hair.

Thallium poisoning in Israel.

We report the first case of thallium poisoning in Israel in almost 30 years. A 40-year-old man was apparently poisoned by a business associate when, on several occasions, he unknowingly drank an alcoholic beverage containing the toxic substance. Delayed admission and recurrent thallium ingestion resulted in both acute and chronic symptoms being present concomitantly. Conventional treatment modalities (Prussian blue and forced diuresis) were employed. The patient survived, although neurological sequelae ensued. The problems encountered in diagnosis and treatment of this relatively uncommon entity are discussed.

An uncommon cause of lower limb weakness.

We describe a case of a severely mentally disabled patient diagnosed as suffering from Guillain-Barré syndrome and treated with repeated plasma exchange. However, the abrupt onset of a cardiovascular collapse prompted a more in-depth diagnostic workup which demonstrated that the neurologic symptoms were likely to be ascribed to poisoning with heavy metals from a large number of ingested coins and other metallic items.