A case of fatal benzalkonium chloride poisoning

Five elderly persons with senile dementia accidentally ingested Hoesmin, a 10% aqueous solution of benzalkonium chloride (BAC). The condition of one patient, an 84-year-old woman whose lips and oral cavity became erythematous, gradually deteriorated. Although gastric lavage was performed, the patient died 3 h after ingestion of Hoesmin. Autopsy revealed corrosive changes of the mucosal surfaces of the tongue, pharynx, larynx, esophagus and stomach which may have come in contact with BAC. In addition, BAC was detected in the serum. We conclude that the patient died of BAC poisoning. Fatal BAC poisoning is rare and autopsy findings in only a few cases of BAC poisoning have been reported. Our findings emphasize the risk of oral ingestion of BAC. Received: 11 August 1997 / Received in revised form: 10 December 1997     

Red cell hypoplasia following autoimmune hemolytic anemia associated with T-CLL: report of a case and review of the literature

A 78-year-old woman, who had axillary lymphadenopathy but no hepatosplenomegaly, was admitted because of lymphocytosis. The leukocyte count was 18.1 x 10(9)/l with 72% abnormal cells. Neither anemia nor thrombocytopenia was present. Many abnormal cells and erythroblasts were seen in the bone marrow. These abnormal cells had irregular nuclei but no granules in the cytoplasm. The surface markers of these cells were positive for E-rosette, CD 2, CD 3, and Leu 7 but negative for CD 4, CD 8, CD 11 (OKM 1), CD 16 (Leu 11), and HLA-DR. The DNA analysis revealed the rearrangement of T-cell receptor beta-chain genes. Direct Coombs test was positive and red-cell life-span (51Cr) was T 1/2 = 19.5 days. The patient was diagnosed as having T-CLL with mild autoimmune hemolysis and was followed without treatment. Seven months later, the leukemia cells of peripheral blood increased to 62.6 X 10(9)/l and the frank autoimmune hemolytic anemia developed. After prednisolone, vincristine and cyclophosphamide were administered, leukemia cells of blood decreased. Anemia with reticulocytopenia, however, persisted and direct Coombs test became negative. In the bone marrow at that time, many neutrophils and megakaryocytes besides leukemia cells were preserved, but erythroblasts were hardly seen, namely a pattern of red cell hypoplasia was observed. The patient deteriorated rapidly and died 26 months after initial recognition of lymphocytosis. When complement was added, the patient's serum obtained during red cell hypoplasia but not during autoimmune hemolysis inhibited BFU-E and CFU-GM in in vitro colony assays. This case indicates that not only B-CLL but also T-CLL is accompanied by immune hematocytopenia.     

A lower trapezius myocutaneous free flap in facial reconstruction: A case report

The free transfer of a myocutaneous flap is the procedure of choice in the reconstruction of facial defects. A case is reported in which a lower trapezius myocutaneous free flap was successfully transferred with microneurovascular anastomoses to repair a facial defect. The advantages of the lower trapezius myocutaneous flap also are discussed.     

Thrombosis-inducing activity found in plasma from two patients with advanced lung cancer

In 2 patients with lung cancer, the coagulation system was supposed to be activated by the findings of elevation of plasma fibrinogen, fibrinogen degradation product (FDP) and/or peripheral platelet counts. The plasma thromboxane B2 and 6-keto-prostaglandin F1 alpha levels in 1 patient were measured and proved to be 160 and 20 times higher than the control level, respectively. When 0.5 ml of plasma from each patient was given intravenously into Balb/c mice, the mice died within 5 min. The multiple thrombosis mainly composed of aggregated platelets and present in the lungs of these mice probably led to death of these animals. On the contrary, no such activity was found in plasma from healthy subjects or other patients with lung cancer who showed no manifestations of enhancement in the coagulation system.