[Prognostic criteria for acute toxic hepatitis].
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Biomedical subjects
Publications and source records attributed to F Conso.
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This kind of poisoning is scarce in France, on the contrary it is most frequent in Eastern Europe. Clinical picture associating cytolytic hepatitis, seizures, and hemolysis reminds us intoxication by hydrazine. In fact there is some evidence that the toxin of this mushroom--called gyromitrin--is transformed in the stomach in methylhydrazine. The mechanism of hepatotoxicity of the later can be compared with that of the metabolites of isoniazid.
The authors present 16 cases of multifocal tuberculosis observed over a period of five years on a general medical unit. These cases almost all occurred in immigrants. (14 out of 16) with at least 2 localisations in 9 of them and sometimes 3 or more. The viscera usually affected were, in order, the liver, the lymph nodes, the lungs and pleura, the joints. They emphasise the mildness of the clinical symptoms, the rareness of lung involvement and, on the contrary, the constancy of hepatic involvement so that needle biopsy of the liver is essential in diagnosis.
Out of 84 patients with colchicine poisoning hospitalised between 1966 and 1976, 11 died during the first 72 hours. Amongst the 73 survivors, 20 showed signs of marrow aplasia between the 3rd and 6th days, lasting on average 4 days. The average amount of colchicine ingested by these patients was 0.5 to 0.8mg/5g. Marrow aplasia was associated with: -- infectious episodes in all cases, -- haemorrhage in 50%, -- dilution hyponatraemia in 25% (but in 50 % of patients if those in renal failure are excluded), -- regressive polyneuropathy in 10 % of cases, -- secondary alopoecia in all cases, -- weight loss of more than 10 % of initial weight in 60 %. Two patients died as a result of septicaemia. This mortality rate of 10 per cent despite the brief duration of the aplasia and the absence of underlying haematological disease would appear to be related to the susceptibility of these poisoned patients to endogenous secondary infections, essentially intestinal in origin.
Out of 124 patients who had taken massive doses of digitoxin in attempted suicide, emergency endocardial pacing was performed in the 68 with the worst prognosis. The mortality (13%) in the 124 patients compared favorably with the mortality (20%) in a previous series of 70 similar patients none of whom were paced. Sixteen (23%) of the 68 paced patients died. The causes of death were: asystole (two); cardiogenic shock (two); septicemia (one); and ventricular fibrillation (eleven). Ventricular fibrillation occurred during introduction of the pacing catheter in two patients, as a result of electrode displacement in these patients, because of premature withdrawal of the catheter in one patient, and for no detectable reason, during normally proceeding pacing, in five patients. Endocardial pacing has a place in the emergency treatment of massive digitoxin poisoning. Its chief hazards are mechanical, and one of the commonest is electrode displacement.
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Potassium permanganate tablets are caustic and it has been suggested that they should be removed straightaway by gastrostomy, immediately after swallowing. Some operators have been impressed by the macroscopic appearance of the stomach and have carried out gastrectomy. However, the lesions were only fairly superficial on pathological examination. In the light of a new case and 21 similar cases, treated at the Fernand Widal hospital, the authors discuss other cases in the literature. They conclude: the extreme rareness of digestive perforation; the absence of toxicity of breakdown products of potassium permanganate. They propose treatment of neutralisation of the permanganate with sodium hyposulphite, gastric lavage and supervision on a surgical unit. In case of perforation, they believe that the operation should be conservative.
The purpose of this study was to estimate the incidence, mortality, and causes of carbon monoxide intoxications in France. A survey was conducted in the department of the Hauts-de-Seine, which is representative of the French population. Data were collected through a headquarters that had direct contact with all department emergency organizations and to a technical laboratory. During the 3-y study, 735 cases that were related to 291 events were reported. Thirty-six patients died. The average incidence of carbon monoxide intoxications was 17.5 per 100,000 inhabitants. Poisoning was caused by fires in 36 events and by car exhausts in 12. For the remaining events, causes were determined as follows for 196: water heaters (57%), boiler (20.5%), coal stove (9%), brazier (4%), cooker (2%), heating device (1.5%), and miscellaneous (6%). The main mechanisms of intoxication were a defective device, poor ventilation, or poor evacuation of combustion gases. Carbon monoxide intoxication occurs frequently in France, and preventive actions are warranted.
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During last 7 years, 13 cases of acute ethylene glycol poisoning have been observed with 4 fatal outbreaks. All cases--except one--were accidental. Six patients had drunk a mixture of antifreeze in water as they were lost in a desert. A patient who had taken 970 ml of ethylene glycol survived. In one case, death was due to irreversible brain damage; two other fatalities occurred from cardiorespiratory distress. CNS involvement was noticed in 8 cases and acute renal failure-constantly controlled-occurred in 9 patients. Post mortem examination has shown bi-refringent calcium oxalate crystals in both kidney and brain. Specific treatment with ethanol has been performed in 3 cases with ingestion of large amounts of toxic who were seen before definitive renal lesions have occurred. Emphasis is placed in symptomatic treatment including gastric lavage, extrarenal epuration and conservative management.