Pérdida visual secundaria a intoxicación inhalatoria y cutánea por metanol y tolueno. A propósito de un caso

Methanol poisoning is often described in the literature, but not transdermal or inhalational poisoning. It usually involves variable multi-organ damage, among which visual, neurological, and gastrointestinal involvement, as well as the metabolic and electrolyte changes that can lead to death. Contact with toluene by occupational or intentional inhalation may also cause neurological abnormalities. This article describes the case of a female patient who was seen in the Emergency Department due to bilateral visual loss secondary to accidental poisoning (inhalation-transdermal) with a solvent containing methanol and toluene. She had a favourable outcome during admission after treatment with ethanol in perfusion and corticosteroids.     

Atención prehospitalaria urgente de los pacientes pediátricos expuestos a tóxicos: características epidemiológico-clínicas y evaluación de la calidad asistencial

ObjectiveTo describe the characteristics of paediatric patients with suspected poisoning treated by advanced life support (ALS) units, and to evaluate quality indicators (QI) for the prehospital emergency care of these patients.MethodA one-year observational study of patients under 18 years of age exposed to poisoning and treated by an ALS unit of the Medical Emergency System in Catalonia. Severe clinical criteria were defined, with 8 QI being evaluated for prehospital emergency care of poisoned paediatric patients.ResultsThe study included a total of 254 patients, with a median age of 14 years-old (p25-75 = 7-16), with intentional poisoning in 50.8% of cases. The most frequently involved toxic agent was carbon monoxide (CO) (33.8%). Poisoning was found in 48.8% of those patients, being serious in 16.5%. Intentionally (OR 5.1; 95% CI: 1.9-13.8) and knowledge of the time of exposure (OD 3.1; 95% CI: 1.3-7.3) were independent risk factors associated with the appearance of severe clinical symptoms. Five QI did not reach the quality standard and included, availability of specific clinical guidelines, activated charcoal administration in selected patients, oxygen therapy administration at maximum possible concentration in carbon monoxide poisoning, electrocardiographic assessment in patients exposed to cardiotoxic substances, and recording of the minimum data set.ConclusionsPaediatric patients attended by ALS units showed specific characteristics, highlighting the involvement of CO and adolescents with voluntary poisoning. The QI assessment was useful to detect weak points in the quality of care of these patients and to develop strategies for improvement.     

沾染液体火箭推进剂时的个人洗消技术进展

目的 回顾与分析国内外有关沾染液体火箭推进剂时个人洗消技术和方法的研究资料，提出有效的个人洗消技术和方法，以尽可能地避免染毒或减轻染毒伤员的伤害程度。资料来源与选择 结合我们已进行的有关研究和参加抢救的临床救治体会，并引用国内外公开发表的相关论文及著作。资料引用 论文28篇及3部专著。资料综合主要针对个人洗消技术的有效性与安全性对文献作者采用的方法和指标进行分析和综合。结论 迅速及时地进行有效的洗消，以尽早彻底清除沾染的毒物，是防治液体火箭推进剂中毒的首要措施，可以明显避免或减轻染毒伤员的伤害程度。     

Fatal poisonings in Jutland (Denmark) during the 1980s

Summary During the period 1980 through 1989 a total of 1029 cases of fatal poisoning (638 men and 391 women) were examined at the Department of Forensic Medicine, Aarhus University, Denmark. In 68% of the cases death had been caused by drugs, whereas acute alcohol poisoning and carbon monoxide accounted for 15% and 14% of the cases, respectively. Alcohol was detected in more than half of the 1029 fatal poisoning cases, and in 42% of all cases the blood alcohol concentration was above 0.8 g/kg. In 57% of the cases death was categorized as accidental, only in 31% of the cases as suicide. Accidental deaths were especially predominant amongst drug and/or alcohol abusers. Propoxyphene was the drug found to have caused most fatal poisonings during the decade (30% of the drug-related deaths). Most of the propoxyphene-related deaths occurred during the early and mid-eighties. Barbiturate poisonings were quite frequent during the first half of the eighties. However, the number of deaths caused by barbiturates decreased significantly after 1986, when most barbiturates were withdrawn from the market. The number of deaths caused by narcotics and analgesics increased during the survey period, while no specific tendency was observed concerning antidepressants.     

TOCP染毒母鸡的神经电生理研究

对TOCP染毒母鸡进行为期7周的神经电生理监测,结果表明,TOCP主要影响远端周围神经,导致坐骨神经远端MCV和SCV减慢及腓肠肌EMG失神经样改变,而胫后神经H反射及重复电刺激无明显异常。     

成批硫化氢中毒抢救的组织与管理

目的 :探讨成批硫化氢中毒患者抢救时的组织与管理。方法 :由护理部及监护室护士长统筹安排 ,将 15位患者分成由 7个监护小组组成的 7个监护小单元实施程序化抢救 ,并统一调配抢救物资、器械。结果 :14例患者抢救成功治愈 ,1例患者心肺复苏成功后死于多脏器功能衰竭。结论 :有效、合理的护理组织与管理 ,能够争取抢救时间 ,提高成批硫化氢中毒患者的抢救成功率。     

贵州省龙里县燃煤污染型氟中毒防治效果20年回顾

目的总结贵州省龙里县20年燃煤污染型氟中毒(地氟病)防治效果,为今后地氟病的防治工作提供依据。方法采用资料回顾性方法,分析近20年来龙里县在防治地氟病工作中,开展流行病学凋查、国家投入为主改良炉灶降氟和开展健康教育干预防治地氟病3个阶段的监测结果。结果①煤、玉米和辣椒含氟量分别超过了900、200、400 mg／kg,水氟正常(<1 mg／L)。②以国家投入为主改良炉灶降氟效果明显好转,但诱发不少消极因素。③健康教育干预后村民防治地氟病知识知晓率和行为转变率增高,学生氟斑牙指数由原来的2．59下降为1．60,尿氟由原来的2.41 mg／L下降至1．45 mg／L。结论龙里县地氟病发生主要是村民不良健康生活习惯引起,以国家投入为主改良炉灶降氟收效甚微,开展健康教育干预是燃煤污染型氟中毒病区防治地氟病投入少、见效快的好方法。     

Caustic burns of the upper digestive and respiratory tracts

In a series of 51 children presenting with an accidental caustic burn, symptoms were analysed for their predictive value of significant i.e. necrotizing oesophageal lesions (grade II or III). For the whole group, the incidence of significant oesophageal lesions was 37%. Vomiting and/or respiratory distress were associated with high incidence of significant oesophageal burn (84% and 75% respectively). The particular location of each caustic burn was analysed for its association with caustic burns at other anatomical sites. Of the 18 patients with a laryngeal burn, 72% also had a grade II or III oesophageal burn. The 19 patients with a grade II or III oesophageal burn and the 18 patients with a laryngeal burn, all had lesions at other sites. In the group of 19 patients with a caustic lesion limited to one site, only 1 patient showed mild oesophagitis (grade I) without late sequelae.     

大鼠高氧暴露导致的肺泡内皮细胞结构和功能的变化(论著)

目的：进一步探索肺氧中毒的机理。方法：在大鼠常压高浓度氧（97％±2％）暴露的早期，观察肺血管紧张素转化酶（ACE）活性、脂质过氧化物（LPO）水平及肺泡毛细血管超微结构的变化。结果：随着肺ACE活性的下降和LPO水平的升高，部分肺泡内皮细胞（EC）出现胞浆水肿，同时肺泡毛细血管内白细胞、血小板明显增多。结论：肺泡EC胞膜功能的受损，尤其是胞膜结合的ACE活性下降所致对炎性介质清除的减少，可能起动了以肺泡EC胞膜通透性增高和炎细胞粘附为特征的早期肺氧中毒。     

我国毒物中毒概况和预防对策

论述了我国生产性职业中毒、运输过程意外事故中毒、环境污染事故中毒、生产性和非生产性农药中毒、食物中毒以及药物中毒.还讨论了中毒的预防对策.