Pathological case of the month. May-Hegglin anomaly.
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Biomedical subjects
Publications and source records attributed to S B Elhassani.
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Neonates are exposed to a growing list of potentially toxic environmental and therapeutic agents. Such exposure may be through mishap, misjudgment in both drug dosage and route of administration, inadvertent misuse of medications, or improper baby care. In addition, the newborn infant may show signs of adverse reactions to a variety of drugs that are given to the mother and cross the placenta, thereby affecting the fetus before or during both labor and delivery. Because of the immaturity of the neonate's liver, lungs, kidneys, and central nervous system, the process of metabolizing and eliminating drugs and poisons is delayed. Moreover, the clinical signs and symptoms of poisoning are not always immediately recognized. Through reviewing various drugs and environmental pollutants, this article places emphasis on prevention rather than treatment.
Thirty-two infants prenatally exposed to methylmercury and their mothers were examined over a five-year period after the Iraqi methylmercury epidemic. Severity of poisoning in mothers was related to the peak mercury concentration in their hair and in the infants to the maximum concentration in maternal hair during pregnancy. In nine cases of cerebral palsy, methylmercury exposure occurred only during the last trimester. All infants except three (two were orphaned soon after birth and one was bottle-fed) were exposed postnatally via suckling. Whereas the mother's symptoms usually improved, the damage to the fetal nervous system appears to be permanent. Milder cases previously not identified in other studies are reported. The syndrome consists of varying degrees of developmental retardation in addition to exaggerated tendon reflexes and the pathologic extensor plantar reflex (minimal brain damage syndrome).
Three children, ages 6 months, 13 months and 10 years were treated by exchange transfusions following exposure to methylmercury in the Iraq outbreak in 1971-72. Two had severe signs of poisoning and the other was clinically normal but had a high blood mercury concentration. Exchange transfusion resulted in clearance of mercury not only from blood but also from other tissues. The average amount of mercury removed in a two hour exchange was estimated as 6% of the body burden as compared to 1% of the body burden removed by normal excretion processes in 24 hours. No dramatic improvement in the clinical condition of the two poisoned patients occurred. Some improvement in motor power and function was observed during follow-up visits to their houses.
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