11/30. Whole bowel irrigation and the cocaine body-packer: a new approach to a common problem.Gastrointestinal drug smuggling is a common problem in many major cities. Though the majority of cases never require medical attention, the "body-packer" frequently presents with life-threatening symptoms of intoxication, including seizures and cardiorespiratory collapse, as well as mechanical obstruction from the ingested drug packets. The risk to asymptomatic smugglers may vary with packaging materials, and remains unknown. Lack of controlled studies, and variations in packaging materials and clinical outcomes have prevented formulation of a consistent management strategy. Current recommendations for asymptomatic body-packers vary from immediate surgical removal, to use of laxatives, to observation. The authors present the first reported case of an asymptomatic cocaine body-packer treated with whole bowel irrigation with polyethylene glycol electrolyte lavage solution. This strategy was safe, well tolerated, resulted in the rapid elimination of drug packets from the gastrointestinal tract, and facilitated assessment by contrast radiography. The potential benefits and limitations for the use of whole bowel irrigation in this difficult problem are discussed.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
12/30. Management of lead foreign body ingestion.Previous reports of lead foreign body (PbFB) ingestion by children include two cases of lead intoxication and two cases that resulted in death. It is generally accepted, however, that PbFB ingestion does not pose a risk of lead toxicity, provided that the PbFB is not retained in the gastrointestinal (GI) tract. Recent experience with two cases substantiates this belief. On separate occasions, two 9-year old girls ingested a PbFB. The first patient developed only mild, vague GI complaints. The highest reported blood lead level (BLL) was 15 mcg/dl. The second patient did not develop symptoms, and the highest reported BLL was 22 mcg/dl. Both patients passed the PbFB in the stool within two weeks. These cases suggest that PbFB ingestions can be treated in a manner similar to other uncomplicated foreign body ingestions.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
13/30. The "cocaine body packer" syndrome. Case report and review of the literature.The cocaine body packer syndrome is seen in drug traffickers swallowing hermetically packed cocaine. The condition can be diagnosed by serial abdominal roentgenograms. The double condom sign and the rosette form are two pathognomonic radiological signs. In the absence of complications, laxatives are administered and the patient is monitored for a prolonged period of time. In the event of a cocaine intoxication due to rupture of a package or in case of a gastrointestinal obstruction, an emergency surgical exploration should be carried out.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
14/30. Increased lead absorption and lead poisoning from a retained bullet.A young man was found to have elevated blood lead and erythrocyte protoporphyrin levels seven years after he had been shot in the foot with a .22 caliber bullet. Although clearly evident in radiographs obtained at the time of the accident, the bullet had never been removed. Over the course of the intervening years the radiographic appearance of the projectile changed dramatically. The patient underwent a surgical debridement procedure with some resolution of his lead intoxication. This case was reviewed in the context of the literature describing the disposition of retained lead projectiles. Lead bullets or fragments lodged within joints are slowly disintegrated and, as absorption accelerates, predispose the patient to the risk of lead poisoning which may occur many years after the original incident. Prompt removal of any lead projectile entering a joint space is strongly recommended.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
15/30. Roentgenographical detection of cocaine smuggling in the alimentary tract.We report five cases of cocaine smuggling, by hiding multiple drug-filled foreign bodies in the colon, either after oral ingestion or by placing them in the colon per rectum. Several smuggling methods in the gastrointestinal (GI) tract and their radiological findings on abdominal plain film are presented. Computed tomography (CT) is found to be a more accurate method in the detection of the drug-filled bags, because of its improved contrast resolution and the absence of projections of overlapping structures on the transversal sections. Subsequently, CT is highly recommended in cases of negative or doubtful findings on conventional abdominal radiographs. In all cases conservative management was used and the drug-filled capsules and condoms passed spontaneously. No complications, such as intestinal obstruction by the bags of cocaine or intoxication by rupture of their wall were observed.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
16/30. copper toxicity following massive ingestion of coins.Two hundred seventy-five united states coins were discovered in the stomach of a mentally disturbed individual at autopsy. Many coins containing copper were corroded by prolonged contact with gastric juice, with subsequent absorption and deposition of copper in the liver and kidneys. The patient died from complications related to the acute toxic phase of chronic copper poisoning. A discussion of the case, foreign-body ingestion, gastric bezoars and the mechanism of copper toxicity is presented. To our knowledge, this is the first death due to copper intoxication following a massive ingestion of coins.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
17/30. lead poisoning from a gunshot wound. Report of a case and review of the literature.A man was hospitalized on three occasions for symptoms of lead intoxication 20 to 25 years after a gunshot wound that resulted in retention of a lead bullet in his hip joint. The potential for lead toxicity as a complication of a lead missile injury appears to be related to (1) the surface area of lead exposed for dissolution, (2) the location of the lead projectile, and (3) the length of time during which body tissues are exposed to absorbable lead. Cases of lead poisoning of immediate onset resulting from lead shot have been reported in europe, but all documented cases of ammunition-related plumbism reported in the united states have involved synovial fluid dissolution of a single lead bullet over many years. The solvent characteristics of synovial fluid and associated local arthritis are apparently important factors in the dissolution and absorption of lead from projectiles located in joints. awareness that lead intoxication can be a complication of retained lead projectiles should allow rapid institution of appropriate diagnostic and therapeutic modalities when such a clinical situation arises.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
18/30. Fatal choking in infants and children.food asphyxiation in infants/children follows a different pattern from the adult "cafe coronary." In the absence of ethanol intoxication, infants/children are prone to mishandling nonfriable, firm, slippery foods/objects with a rounded contour. The Dade County Medical Examiner's files were searched from 1956 to mid-1983 for accidental pediatric choking deaths. Seventeen food and six foreign body asphyxiations were found. The male/female ratio was 1.4/1 and 1/1, respectively. The white/black ratio was 0.9/1 for food asphyxiation whereas no black victims were encountered choking upon foreign objects. Seventy-eight percent of all victims were between 2 months and 4 years of age. Infants/children asphyxiated on items such as a hot dog, hard candy, peanut, toy rattle, tissue paper, balloon, marble, etc. The choking event was recognized by nearby adults in most instances. risk factors include the availability of riskful foods/objects, natural diseases with difficulty feeding, poor eating habits, and uneducated or ignorant parents/others at the scene. Although public education, package labeling, and changes in food/object design may be appropriate, the ubiquituous risk foods and small foreign objects will, on occasion, escape the eye of even the most watchful parent.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
19/30. Drug smuggling by internal bodily concealment.The smuggling of illicit drugs, either swallowed or inserted into the rectum or vagina, is gaining in popularity, particularly in view of the difficulty of its detection and the potentially large financial gains. Such contraband includes heroin (especially in western australia), cocaine, and marijuana and its derivatives. This practice is not without complications--drug intoxication, which may be fatal, and intestinal obstruction by foreign bodies have been reported. We review the cases of "body packing" reported in the literature and those detected in western australia over the past two years, and describe three cases of the ingestion of heroin-filled condoms, with resultant complications.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
20/30. The gastrointestinal tract as a vehicle for drug smuggling.Four cases of attempts to smuggle narcotics (marijuana, heroin, and cocaine) by swallowing a large number of drug-filled foreign bodies (condoms and capsules) and hiding them from customs authorities in the gastrointestinal canal during transit are described. This is compared with a psychiatric patient who swallowed 48 Vicks Inhalers. Drug smuggling by swallowing condoms or capsules containing narcotics is now a worldwide ethical-legal problem. It also is of therapeutic and prognostic importance as this may lead to such emergencies as mechanical obstruction, rupture of the drug-containing foreign bodies, and life-threatening intoxication of the carrier.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
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