BACKGROUND:The aim of the present study is to describe the clinical correlates of hypotension and its associated outcomes in patients with acute organophosphorus poisoning(AOPP).METHODS:In this retrospective cohort st...BACKGROUND:The aim of the present study is to describe the clinical correlates of hypotension and its associated outcomes in patients with acute organophosphorus poisoning(AOPP).METHODS:In this retrospective cohort study,we analyzed data pertaining to 871 patients with AOPP who were treated at two hospitals.Data from hypotensive and non-hypotensive patients were compared to identify clinical correlates of hypotension.We also evaluated the association between clinical parameters(including hypotension)and in-hospital mortality.RESULTS:The incidence of hypotension in AOPP patients was 16.4%.Hypotensive patients showed signifi cantly higher in-hospital mortality(1.1%vs.39.9%,P<0.001).Advanced age(odds ratio[OR]1.25,95%confi dence interval[CI]1.08–1.44),history of diabetes(OR 2.65,95%CI 1.14–5.96),and increased white blood cell count(OR 1.06,95%CI 1.03–1.09),plasma cholinesterase(OR 0.91,95%CI 0.84–0.94),plasma albumin(OR 0.88,95%CI 0.85–0.92),serum amylase(OR 1.01,95%CI 1.01–1.02),and blood pH(OR 0.64,95%CI 0.54–0.75)were signifi cantly associated with hypotension.After adjusting for potential confounders,hypotension was associated with increased in-hospital mortality(hazard ratio 8.77–37.06,depending on the controlled variables).CONCLUSIONS:Hypotension is a common complication of AOPP and is associated with increased in-hospital mortality.Advanced age,history of diabetes,and changes in laboratory parameters were associated with hypotension in AOPP patients.展开更多
Objective: Gastric lavage is mandatory irrespective of nature in all patients with acute poisoning in India. Present study was undertaken with aim whether lavage done using nasogastric Ryle’s tube and small aliquots ...Objective: Gastric lavage is mandatory irrespective of nature in all patients with acute poisoning in India. Present study was undertaken with aim whether lavage done using nasogastric Ryle’s tube and small aliquots of water or normal saline is safe. Patients and Methods: All the patients above 12 years of age admitted consecutively with pesticide ingestion or exposure between July 2004 to June 2005 were studied with respect to complications associated with lavage using Ryle’s tube. Forty five patients were admitted directly to our hospital and lavage was undertaken using Ryle’s tube (16F ) with 100 - 200 mL of aliquots till 1 - 1.5 liters of fluid was lavaged, with prophylactic endotracheal intubation in patients with Glasgow coma scale ( GCS) < 10 (group I). The incidence of complications related to lavage in group I was compared to that in 53 patients admitted during same period with pesticide poisoning but lavaged outside using nasogastric Ryle’s tube and referred to our institute (group II). Results: The significant complications observed in group I were significant drop in SaO2 (6 patients) laryngospasm, tachycardia, electrolyte imbalance and tube getting struck in throat (one each). In one patient in group I (had no prophylactic intubation though GCS 3) In group II, 7 had aspiration pneumonia (no prophylactic intubation). Other significant complication was drop in SaO2 during lavage. None of them had any serious life threatening complication. Conclusion: Gastric lavage carried out using nasogastric Ryle’s tube and small aliquots of water or normal saline is relatively safe in patients with pesticide poisoning when combined with prophylactic endotracheal intubation in patients with GCS < 10. In absence of prophylactic intubation, risk of aspiration is there. However aspiration pneumonia is generally mild and not life threatening.展开更多
BACKGROUND： The pathways induced/activated by mercury poisoning that lead to muscle pain remain unclear. The present study addressed the structural changes observed in the peripheral nerve following mercury poisoning...BACKGROUND： The pathways induced/activated by mercury poisoning that lead to muscle pain remain unclear. The present study addressed the structural changes observed in the peripheral nerve following mercury poisoning. OBJECTIVE： To establish the mercury poison rat model, rats were intragastrically administered mercury, The correlation between post-mercury poison-induced muscular pain and tibial nerve morphological changes were observed. DESIGN： Observational contrast animal study. SETTING： Shangdong Academy of Occupational Health and Occupational Medicine. MATERIALS： Thirty adult Sprague Dawley rats of equal gender. Mercury chloride （HgCl2, analytical grade： 99.99%; batch number： 990402） was provided by Shanghai Chemical Reagent Factory, and sodium dimercaptopropanesulfonate （DMPS） injection by Shanghai Harvest Pharmaceutical Co., Ltd. （batch number： 0309011）. METHODS： This study was performed at the Animal Experimental Center of Shangdong Academy of Occupational Health and Occupational Medicine from December 2005 to January 2006. Rats were randomly divided into high-dose mercury, low-dose mercury, and control groups, with 10 rats in each group. Rats in the two mercury groups were intragastrically administered 17 mg/kg and 8.5 mg/kg HgCl2 solution, respectively, once a day to establish a rat model of subacute mercury poisoning. Rats in the control group were intragastrically administered 2 mL saline, once a day. Intragastric administration in the three groups lasted for （20± 2） days. After model establishment, rats in the two mercury groups were injected DMPS once a day to remove mercury. The injection lasted for 3 days after every 4-day interval. Seven days was regarded as one treatment cycle, and there were two treatment cycles in total. MAIN OUTCOME MEASURES： Mercury-induced muscular pain status; ultrastructural changes of the right tibial nerve following model establishment and mercury removal under transmission electron microscope. RESULTS： Thirty rats were included in the final analysis. Muscular pain status： one rat exhibited mercury-induced muscular pain. Red swelling of the skin was observed on the posterior claws, lower limbs, and tail. The rat incessantly licked and scratched the red swelling of the skin, turned over, and occasionally hissed. The axon myelin sheath of the tibial nerve was intact, clear, and dense. The mitochondrial membrane was intact and smooth, and the cristallin was clear. Microfilaments and microtubules were tightly arranged. Axon pathological changes and demyelination lesion occurred in the right tibial nerve in the two mercury groups. However, mercury removal with DMPS for two treatment cycles did not inhibit the peripheral nerve lesion. In the pain model rats, the myelin sheath of the tibial nerve was mottled. Mitochondria in the axoplasm were swollen, the structure was unclear, numbers were decreased, and cristallin disappeared. The mitochondrial membrane was broken, and the microfilament was reduced and unorganized. After two treatment cycles of mercury removal with DMPS, nerve demyelination lesion was aggravated, and the myelin sheath was increasingly mottled. Both rarefaction degeneration and vacuolar transformation were observed in most of the axon myelin sheath. The axonal membrane was damaged to a certain degree. CONCLUSION： Subacute HgCl2 poisoning might result in tibial nerve injury. The myelin sheath of the tibial nerve was mottled in mercury poisoned rats without muscular pain. Nevertheless, the correlation between mercury poisoning and pain remains unclear. The injured tibial nerve of the rats was not repaired after dimercaptopropanesulfonate treatment.展开更多
BACKGROUND Despite negligible absorption of elemental mercury after acute ingestion,retention in the appendix with subsequent local and systemic complications is possible. We present a case of elemental mercury seques...BACKGROUND Despite negligible absorption of elemental mercury after acute ingestion,retention in the appendix with subsequent local and systemic complications is possible. We present a case of elemental mercury sequestration in the appendix,managed by laparoscopic appendectomy.CASE SUMMARY A 57-year-old Caucasian female was found unconscious following application of long-lasting insulin detemir and ingestion of elemental mercury in a suicidal attempt. Diagnostic investigations revealed several radiopaque collections in the gastrointestinal(GI) tract and elevated mercury levels in the blood. Much of the ingested elemental mercury was eliminated from the GI tract with stools stimulated by several enemas. However, a significant amount of mercury remained sequestrated in the appendix despite all conservative measures.Consequently, following deliberations by an interdisciplinary team of specialists,laparoscopic appendectomy was performed 29 d after the mercury ingestion. The surgery itself and postoperative course were uneventful.CONCLUSION Since conservative measures are often unsuccessful in the management of mercury retention in the appendix, surgery remains a compelling option to prevent possible associated complications.展开更多
基金approved by the Medical Ethics Committee of the First Hospital of Jilin University(approval number:2018-146).
文摘BACKGROUND:The aim of the present study is to describe the clinical correlates of hypotension and its associated outcomes in patients with acute organophosphorus poisoning(AOPP).METHODS:In this retrospective cohort study,we analyzed data pertaining to 871 patients with AOPP who were treated at two hospitals.Data from hypotensive and non-hypotensive patients were compared to identify clinical correlates of hypotension.We also evaluated the association between clinical parameters(including hypotension)and in-hospital mortality.RESULTS:The incidence of hypotension in AOPP patients was 16.4%.Hypotensive patients showed signifi cantly higher in-hospital mortality(1.1%vs.39.9%,P<0.001).Advanced age(odds ratio[OR]1.25,95%confi dence interval[CI]1.08–1.44),history of diabetes(OR 2.65,95%CI 1.14–5.96),and increased white blood cell count(OR 1.06,95%CI 1.03–1.09),plasma cholinesterase(OR 0.91,95%CI 0.84–0.94),plasma albumin(OR 0.88,95%CI 0.85–0.92),serum amylase(OR 1.01,95%CI 1.01–1.02),and blood pH(OR 0.64,95%CI 0.54–0.75)were signifi cantly associated with hypotension.After adjusting for potential confounders,hypotension was associated with increased in-hospital mortality(hazard ratio 8.77–37.06,depending on the controlled variables).CONCLUSIONS:Hypotension is a common complication of AOPP and is associated with increased in-hospital mortality.Advanced age,history of diabetes,and changes in laboratory parameters were associated with hypotension in AOPP patients.
文摘Objective: Gastric lavage is mandatory irrespective of nature in all patients with acute poisoning in India. Present study was undertaken with aim whether lavage done using nasogastric Ryle’s tube and small aliquots of water or normal saline is safe. Patients and Methods: All the patients above 12 years of age admitted consecutively with pesticide ingestion or exposure between July 2004 to June 2005 were studied with respect to complications associated with lavage using Ryle’s tube. Forty five patients were admitted directly to our hospital and lavage was undertaken using Ryle’s tube (16F ) with 100 - 200 mL of aliquots till 1 - 1.5 liters of fluid was lavaged, with prophylactic endotracheal intubation in patients with Glasgow coma scale ( GCS) < 10 (group I). The incidence of complications related to lavage in group I was compared to that in 53 patients admitted during same period with pesticide poisoning but lavaged outside using nasogastric Ryle’s tube and referred to our institute (group II). Results: The significant complications observed in group I were significant drop in SaO2 (6 patients) laryngospasm, tachycardia, electrolyte imbalance and tube getting struck in throat (one each). In one patient in group I (had no prophylactic intubation though GCS 3) In group II, 7 had aspiration pneumonia (no prophylactic intubation). Other significant complication was drop in SaO2 during lavage. None of them had any serious life threatening complication. Conclusion: Gastric lavage carried out using nasogastric Ryle’s tube and small aliquots of water or normal saline is relatively safe in patients with pesticide poisoning when combined with prophylactic endotracheal intubation in patients with GCS < 10. In absence of prophylactic intubation, risk of aspiration is there. However aspiration pneumonia is generally mild and not life threatening.
基金the grants from Shandong Medical Academy, No. 2004-023
文摘BACKGROUND： The pathways induced/activated by mercury poisoning that lead to muscle pain remain unclear. The present study addressed the structural changes observed in the peripheral nerve following mercury poisoning. OBJECTIVE： To establish the mercury poison rat model, rats were intragastrically administered mercury, The correlation between post-mercury poison-induced muscular pain and tibial nerve morphological changes were observed. DESIGN： Observational contrast animal study. SETTING： Shangdong Academy of Occupational Health and Occupational Medicine. MATERIALS： Thirty adult Sprague Dawley rats of equal gender. Mercury chloride （HgCl2, analytical grade： 99.99%; batch number： 990402） was provided by Shanghai Chemical Reagent Factory, and sodium dimercaptopropanesulfonate （DMPS） injection by Shanghai Harvest Pharmaceutical Co., Ltd. （batch number： 0309011）. METHODS： This study was performed at the Animal Experimental Center of Shangdong Academy of Occupational Health and Occupational Medicine from December 2005 to January 2006. Rats were randomly divided into high-dose mercury, low-dose mercury, and control groups, with 10 rats in each group. Rats in the two mercury groups were intragastrically administered 17 mg/kg and 8.5 mg/kg HgCl2 solution, respectively, once a day to establish a rat model of subacute mercury poisoning. Rats in the control group were intragastrically administered 2 mL saline, once a day. Intragastric administration in the three groups lasted for （20± 2） days. After model establishment, rats in the two mercury groups were injected DMPS once a day to remove mercury. The injection lasted for 3 days after every 4-day interval. Seven days was regarded as one treatment cycle, and there were two treatment cycles in total. MAIN OUTCOME MEASURES： Mercury-induced muscular pain status; ultrastructural changes of the right tibial nerve following model establishment and mercury removal under transmission electron microscope. RESULTS： Thirty rats were included in the final analysis. Muscular pain status： one rat exhibited mercury-induced muscular pain. Red swelling of the skin was observed on the posterior claws, lower limbs, and tail. The rat incessantly licked and scratched the red swelling of the skin, turned over, and occasionally hissed. The axon myelin sheath of the tibial nerve was intact, clear, and dense. The mitochondrial membrane was intact and smooth, and the cristallin was clear. Microfilaments and microtubules were tightly arranged. Axon pathological changes and demyelination lesion occurred in the right tibial nerve in the two mercury groups. However, mercury removal with DMPS for two treatment cycles did not inhibit the peripheral nerve lesion. In the pain model rats, the myelin sheath of the tibial nerve was mottled. Mitochondria in the axoplasm were swollen, the structure was unclear, numbers were decreased, and cristallin disappeared. The mitochondrial membrane was broken, and the microfilament was reduced and unorganized. After two treatment cycles of mercury removal with DMPS, nerve demyelination lesion was aggravated, and the myelin sheath was increasingly mottled. Both rarefaction degeneration and vacuolar transformation were observed in most of the axon myelin sheath. The axonal membrane was damaged to a certain degree. CONCLUSION： Subacute HgCl2 poisoning might result in tibial nerve injury. The myelin sheath of the tibial nerve was mottled in mercury poisoned rats without muscular pain. Nevertheless, the correlation between mercury poisoning and pain remains unclear. The injured tibial nerve of the rats was not repaired after dimercaptopropanesulfonate treatment.
文摘BACKGROUND Despite negligible absorption of elemental mercury after acute ingestion,retention in the appendix with subsequent local and systemic complications is possible. We present a case of elemental mercury sequestration in the appendix,managed by laparoscopic appendectomy.CASE SUMMARY A 57-year-old Caucasian female was found unconscious following application of long-lasting insulin detemir and ingestion of elemental mercury in a suicidal attempt. Diagnostic investigations revealed several radiopaque collections in the gastrointestinal(GI) tract and elevated mercury levels in the blood. Much of the ingested elemental mercury was eliminated from the GI tract with stools stimulated by several enemas. However, a significant amount of mercury remained sequestrated in the appendix despite all conservative measures.Consequently, following deliberations by an interdisciplinary team of specialists,laparoscopic appendectomy was performed 29 d after the mercury ingestion. The surgery itself and postoperative course were uneventful.CONCLUSION Since conservative measures are often unsuccessful in the management of mercury retention in the appendix, surgery remains a compelling option to prevent possible associated complications.
