急性铊中毒一例

患者男,39岁,反复发作腹痛1月余,脱发、双下肢感觉异常、精神障碍半个月,视力下降半年,于2008年3月5日入住本院职业病科.1月下旬,该患者在无诱因情况下突发腹痛,伴腰痛,多家医院疑诊急性胰腺炎、胆囊炎等,予以对症治疗后腹痛程度虽有缓解,但仍反复发作,并间断性出现胸闷、呼吸急促、出冷汗,并有双眼流泪、眼痛、视物模糊等症状.2月下旬,该患者出现脱发、双下肢袜套样针刺感觉过敏、四肢末梢甲周小片状色素沉着、烦躁及阵发性言语错乱,精神科拟诊躯体疾病伴发精神障碍.     

电感耦合等离子体质谱法测定铊中毒事件中铊含量

目的：用电感耦合等离子体质谱法测定铊中毒样品并考察其方法学。方法：优化仪器工作参数,用内标溶液校正基体效应干扰,用电感耦合等离子体质谱测定各样品铊含量。结果：本法的检出限为0.008μg/L,回收率96.8%~104.8%。经测定在尿样和餐具中检出高浓度铊。结论：用电感耦合等离子体质谱法测定铊中毒样品是一种灵敏快速、简便准确的方法。     

急性铊中毒4例临床分析

结合有关文献,分析4例铊中毒的临床特征、铊定量结果及治疗方法。     

血液灌流救治铊中毒一例

我们应用血液灌流技术成功抢救1例急性铊中毒患者,现报告如下. 一、临床资料 1.一般资料:患者男,32岁,为某企业化验室的临时工.2008年7月某日上午10时许,该患者发现玻璃皿中有些白色粉末,用左手中指蘸取少许欲品尝,恐有毒随即挥手弹掉,但未洗手进午餐,左手(被粉尘污染)持馒头进食.     

铊中毒性神经系统损害的临床研究

铊属于高毒类,可引起多器官系统的损害,临床表现多种多样,神经系统为其最主要的靶器官,其损害也较为严重和持久.本文主要对急性铊中毒所致神经系统损害的临床特点及其病理、神经电生理学等相关研究进行综述.     

Erosion of nails following thallium poisoning: a case report

This case report describes a patient with thallium poisoning caused by repeated exposure to low doses of thallium. Alopecia and nail changes were the most prominent features of this case. There was dystrophy of nails in the form of whitish lunular stripes. This is the first report of complete erosion of proximal parts of nails following thallium poisoning. This case is the first report of thallium poisoning from India occurring from repeated low dose exposure.     

对职业性铊中毒标准修订的探讨

目的提出职业性铊中毒诊断标准的主要修订内容。方法通过对铊中毒临床特点的简要复习,结合标准对修订内容进行讨论。结果职业性铊中毒诊断标准中急性中毒的分级由轻度、重度2级细化为轻度、中度和重度3级;提出尿铊的正常参考值和职业接触生物限值,引入急性铊中毒临床诊断参考值;将神经肌电图作为急性、慢性铊中毒的诊断起点条件之一,不再列为病情分级条款;根据国家药品管理的有关规定,将原标准正文中涉及药物改在附录中说明。结论根据上述结果对职业性铊中毒诊断及分级标准、有关辅助检查及处理原则的部分内容进行了修订。     

罕见的铅铊合并急性中毒病例分析

报道１ 例因误食所致铅、铊合并急性中毒病例的诊断和治疗,并对其采用的多种治疗方法进行评价。     

血液灌流治疗急性铊中毒2例血铊尿铊观察

分析2例急性铊中毒患者采用血液灌流(hemoper-fusion,HP)治疗前后血铊和尿铊的变化,并计算下降率。观察治疗前后患者血电解质,肝、肾功能及血常规变化并评价临床症状的改变。HP治疗可显著减低血铊、尿铊水平,血铊的下降率为(40±10)%,尿铊的下降率为(90±5)%,患者分别经5～6次治疗后血铊、尿铊水平基本接近正常,临床症状明显改善。其中1例重症患者血液灌流过程中曾出现一过性的血钙、血钾、血小板减少。血液灌流能有效清除人体内已吸收的铊,临床需密切观察血电解质、肝、肾及血常规的变化,及时给予对症和支持治疗。     

Cerebellar atrophy as a delayed manifestation of chronic carbon disulfide poisoning

A 70-year-old man developed a slowly progressive cerebellar syndrome after having been exposed to carbon disulfide (CS2) in a viscose rayon plant for 27 years. Ataxia, dysmetria, dysarthria and adiadochokinesia appeared 7 years after retirement from work (at age 54), and were later accompanied by cognitive deterioration, dysmnesia, spatio-temporal disorientation, emotional lability, and paranoid-obsessive disturbances. Brain computed tomography (CT) and magnetic resonance imaging (MRI) showed advanced global cerebellar atrophy, and a picture of less severe cerebrocortical atrophy. The case illustrates the possibility of chronic toxic encephalopathy among patients with previous long-term exposure to CS2. In such instances, cerebellar damage may develop as an exceptional, delayed manifestation of neurotoxicity: brain imaging techniques can significantly contribute to the diagnosis and follow-up, in addition to occupational anamnesis and neuropsychiatric evaluation. The patient presented also serves as a remainder that neurodegenerative disorders of apparently unknown origin sometimes derive from occupational toxic exposures suffered in the past. The clinical manifestations may appear several years after retirement from work, when the effects of toxic damage combine with age-related neuronal loss to overcome the brain functional reserve.     

急性铊中毒5例的急救与护理

目的 总结5例急性铊中毒的护理体会.方法 回顾分析广西壮族自治区职业病防治研究院2012年9月住院的5例急性铊中毒患者的救治与护理过程.结果 5例确诊为铊中毒患者经血液灌流和口服普鲁士蓝、利尿、补钾、补液、护肝治疗,同时加强护理,5例患者住院时间15～27 d,痊愈出院,随诊重新长出头发及无后遗症.结论 铊毒性强,中毒后应用普鲁士蓝联合血液灌流治疗方案,对患者实施个体化的整体护理,效果显著.     

Pesticide poisoning and depressive symptoms among farm residents

PURPOSE: The purpose of the study presented is to evaluate the association between pesticides and depressive symptoms among a population exposed to chemicals as a result of agricultural use. Chronic sequelae of acute pesticide poisoning from organophosphate compounds may include anxiety and depression. In some states, farmers have been reported to have higher rates of depression than other population groups. Little work has been done to describe the effects of exposure to organophosphate compounds and depressive symptoms among the farming population. METHODS: Data for this study came from a cross sectional survey of farmers and their spouses conducted in an eight county area in northeastern Colorado. Personal interviews were conducted with the study participants. Depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression (CES-D) scale. Pesticides applied on the farms were assessed using self-reported questionnaires. Conditional logistic regression was used to model the relationship between depression and pesticide-related illness in a stratified analysis. RESULTS: Between 1992-1997, 761 individuals were enrolled in this cross sectional survey. Adjusting for a number of potential confounders, the odds ratio for depression associated with pesticide-related illness was 5.87 [95% confidence interval (CI) = 2.56-13.44]. CONCLUSIONS: Exposure to pesticides at a high enough concentration to cause self reported poisoning symptoms was associated with high depressive symptoms independently of other known risk factors for depression among farm residents.     

Sources, symptoms, and signs of arsenic poisoning

Arsenic poisoning continues to be a serious medical problem that may easily be overlooked or misdiagnosed. The broad constellation of symptoms and signs in arsenic poisoning, along with changing sources of this toxin, contributes to misdiagnosis. A re-examination of current potential sources was carried out. Sources were determined in 17 of 20 documented cases of arsenic poisoning. Fourteen cases resulted from ingestion of a single, commonly available, arsenic-containing ant killer. In contrast to earlier reports, this survey found that agricultural and industrial sources were relatively uncommon. A peculiar posturing of the hand is commonly seen in the early stages of arsenic poisoning prior to the development of Mee's lines or palmar hyperkeratosis. An illustrative case is reported that resulted from intermittent self-administration of an arsenic-containing ant killer in order to maintain a state of chronic invalidism.