11/39. Acute arsenical myopathy: morphological description.We describe the histological findings of the muscle in a case of acute voluntary massive arsenic intoxication resulting in severe rhabdomyolysis. The main features on muscle biopsy were perifascicular hypercontracted fibers, myofibrillar disruption, mitochondrial abnormalities and abundant cytoplasmic vacuoles containing lipids.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
12/39. Arsenic intoxication presenting as a myelodysplastic syndrome: a case report.A case of arsenic intoxication presenting as a myelodysplastic syndrome is reported. A 41-year-old woman with a 6-month history of gastrointestinal and neurological symptoms was noted to be pancytopenic at presentation. A bone marrow aspirate revealed dysmyelopoietic changes involving all three marrow cell lines. Subsequent analysis of urine for heavy metals demonstrated very high levels of arsenic. Treatment with British anti-Lewisite (BAL) resulted in the resolution of gastrointestinal symptoms and hematological abnormalities although the neurological complications progressed. This case emphasizes that heavy metal intoxication should be considered in the differential diagnosis of any individual presenting with the hematological features of myelodysplasia especially when accompanied by clinical features considered atypical for primary or secondary myelodysplasia.- - - - - - - - - - ranking = 6keywords = intoxication (Clic here for more details about this article) |
13/39. Epithelioid angiosarcoma of the adrenal gland associated with chronic arsenical intoxication?Epithelioid angiosarcoma is a rare tumor quite recently described. There is no accurate epidemiological study of this tumor. Among the internal organs, the liver is the one most frequently affected with angiosarcoma while there is no reference to the adrenal gland as a primary site. It is well known that the direct exposure to arsenicals (especially of vineyard cultivators) may be an important causative factor in the pathogenesis of the disease. A 59-year-old male vineyard cultivator with an epithelioid angiosarcoma of the right adrenal gland is described. The histologic characteristics as well as the immunohistochemical profile of the tumor are presented and the literature is briefly reviewed.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
14/39. Polyneuropathy due to acute arsenic intoxication: biopsy studies.A 41-year-old vintner attempting suicide ingested 8-9 g of arsenic and developed a symmetric polyneuropathy with acute wallerian degeneration of myelinated fibers. Under treatment with modified British Anti-Lewisite (BAL; "Dimaval") his polyneuropathy slowly, but incompletely, subsided over three years at which time another sural nerve biopsy specimen showed regenerative proliferation of myelinated and unmyelinated axons but no signs of wallerian degeneration. By laser microprobe mass analysis (LAMMA) arsenic was located in the first biopsied sural nerve specimen but not in the second specimen. These findings demonstrated: 1) arsenic induced serial morphometric and electron microscopic findings of nerve fiber degeneration and regeneration, 2) documentation of arsenic within myelinated nerve fibers, and 3) the usefulness of the LAMMA technique as a diagnostic procedure in this context.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
15/39. Acute respiratory failure following severe arsenic poisoning.A 47-year-old man had an episode of severe respiratory failure after acute intoxication with arsenic. Features of the initial clinical presentation included nausea, vomiting, and diarrhea, acute psychosis, diffuse skin rash, and marked pancytopenia. A peripheral neuropathy then developed which resulted in severe weakness of all muscles of the limbs, the shoulder and pelvis girdles, and the trunk. The neuropathy continued to progress despite treatment with dimercaprol (BAL in oil). Five weeks after the initial exposure, the patient was no longer able to maintain adquate ventilation and required mechanical ventilatory support. Improvement in the patient's neuromuscular status permitted successful weaning from the ventilator after one month of mechanical ventilation. Long-term follow-up revealed no further respiratory difficulty and slow improvement in the strength of the peripheral muscles.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
16/39. Acute arsenic intoxication from environmental arsenic exposure.Reports of acute arsenic poisoning arising from environmental exposure are rare. Two cases of acute arsenic intoxication resulting from ingestion of contaminated well water are described. These patients experienced a variety of problems: acute gastrointestinal symptoms, central and peripheral neurotoxicity, bone marrow suppression, hepatic toxicity, and mild mucous membrane and cutaneous changes. Although located adjacent to an abandoned mine, the well water had been tested for microorganisms only and was found to be "safe." Regulations for testing of water from private wells for fitness to drink are frequently nonexistent, or only mandate biologic tests for microorganisms. Well water, particularly in areas near mining activity, should be tested for metals.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
17/39. Acute arsenic intoxication.The diagnosis of acute arsenic poisoning should be considered in any patient presenting with severe gastrointestinal complaints. signs and symptoms include nausea, vomiting, colicky abdominal pain and profuse, watery diarrhea. hypotension, fluid and electrolyte disturbances, mental status changes, electrocardiographic abnormalities, respiratory failure and death can result. Quantitative measurement of 24-hour urinary arsenic excretion is the only reliable laboratory test to confirm arsenic poisoning. Treatment includes gastric emesis or lavage, chelation therapy, electrolyte and fluid replacement, and cardiorespiratory support.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
18/39. Acute arsenic intoxication presenting as Guillain-Barre-like syndrome.Arsenic-induced polyneuropathy is traditionally classified as an axonal-loss type, electrodiagnostically resulting in low amplitude or absent sensory and motor responses, relatively preserved proximal and distal motor conduction rates, and distal denervation. We report four patients with a subacute onset progressive polyradiculoneuropathy following high-dose arsenic poisoning. In three patients, early electrodiagnostic testing demonstrated findings suggestive of an acquired segmental demyelinating polyradiculoneuropathy. Serial testing confirmed evolution into features of a distal dying-back neuropathy. We hypothesize that arsenic toxicity and the resultant biochemical derangement of the peripheral nerve cell leads to subtle changes in axonal function that produce, initially, segmental demyelination and eventually distal axonal degeneration. Acute arsenic toxicity must be suspected in patients with clinical and electrodiagnostic features supporting guillain-barre syndrome.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
19/39. survival following massive arsenic ingestion.A case of a 30-year-old man who ingested a massive quantity of arsenic (approximately 2,150 mg) in an apparent suicide attempt is presented. Aggressive initial therapy, including fluid resuscitation, chelation therapy, and hemodialysis, resulted in the patient's survival. The successful management of arsenic intoxication requires both prompt recognition and the initiation of specific and aggressive therapeutic modalities.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
20/39. Unusual manifestations of arsenic intoxication.A patient with arsenic intoxication is reported, who presented with a variety of gastrointestinal and neurologic disturbances including unilateral facial nerve palsy and acute symptomatic pancreatitis, neither of which have been previously described as sequelae of arsenic poisoning. The patient also suffered hematologic, dermatologic, and cardiopulmonary complications. A review of the literature about this interesting problem is also presented.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
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