Methaemoglobinaemia due to amyl nitrite inhalation: a case report.

Methaemoglobinaemia is a potential toxic effect of aliphatic nitrites which are increasingly abused by male homosexuals and drug addicts because of marked vasodilating properties ('poppers'). In most instances, severe complications were described following the ingestion of large quantities of amyl, butyl or isobutyl nitrites. A deficiency in NADH-dependent haemoglobin reductase in some patients has been noted. This is the first report of symptomatic methaemoglobinaemia following the inhalation of amyl nitrite.

[Acute alveolitis after using a waterproofing aerosol: apropos of 2 cases]. / Alvéolite aiguë après utilisation d'un aérosol imperméabilisant: à propos de deux observations.

INTRODUCTION: Waterproofing sprays for leather clothing have seldom been involved in severe accidents. In some circumstances, their pulmonary toxicity is marked, as shown by two case reports and a review of the literature. EXEGESIS: Acute alveolitis is described in two young adults without previous respiratory illness, following the use of a waterproofing spray for leather clothing. Clinical features typical of a flu-like reaction (malaise, fever and chills) were associated with dyspnea and with hemoptysis in one patient. X-ray examination evidenced lesional edema which quickly resolved after symptomatic treatment. The toxic mechanism is debated, but experimental data and clinical findings suggest the causative role of recently introduced fluoropolymers. CONCLUSIONS: Waterproofing sprays for leather clothing may induce severe respiratory illness after massive inhalation in confined area. Treatment is supportive.

[A "historical" case of lead poisoning via drinking water: diagnostic and therapeutic issues]. / Un cas "historique" de saturnisme hydrique: difficultés diagnostiques et thérapeutiques.

INTRODUCTION: It is likely that lead poisoning via drinking water is often overlooked because of its supposed rarity and nonspecific early symptoms, which result in delayed management. EXEGESIS: One case of severe lead poisoning via drinking water is reported. The diagnosis was long missed and a particularly long chelating treatment was required. The clinical features included lead colic, a Burton's lead line, anemia, polyneuritis and arterial hypertension. Eighteen courses of calcium EDTA were required to obtain 'biological recovery'. The poisoning was linked to a very long water supply lead pipe and potomania secondary to alcohol withdrawal. CONCLUSION: This case report illustrates how difficult the early recognition of lead poisoning can be, and underlines the need to inquire about a toxic aetiology, particularly via the environment, of otherwise unexplained pathological conditions.

[Severe ocular burns by calcium carbide in a speleologist: a case report]. / Brûlures oculaires sévères par le carbure de calcium chez un spéléologue amateur.

A case of severe ocular burns in an amateur speleologist is reported. The explosion of his acetylene lamp caused the projection of calcium carbide particles, which induced burning of the cornea and conjunctiva in both eyes. He slowly recovered in several months. The pathophysiology of the burns, linked to the in situ production of lime, and their management are discussed.

[Respiratory distress in three newborns after mask disinfection with Endosporine. Probable role of glutaraldehyde]. / Détresse respiratoire chez trois nouveau-nés après désinfection des masques par l'Endosporine. Rôle probable du glutaraldéhyde.

BACKGROUND: Disinfectants for medical devices are uncommonly a cause of iatrogenic adverse effects. Nevertheless, when misused, they can induce severe complications. Three cases of acute respiratory distress in newborns probably induced by glutaraldehyde are reported. CASE REPORTS: Three children born by Caesarean section between 8 and 19 May 1999 in the same hospital presented acute respiratory distress requiring hospitalization in the neonatal intensive care unit; one child was premature. The clinical appearance, which was initially normal, deteriorated with a respiratory distress in 30 to 60 minutes. Recovery was uneventful in all cases. The diagnosis considered was a hyaline membrane disease. The enquiry conducted after this cluster onset identified, as a main contributing factor, the disinfection procedure recently introduced in the surgical theater. CONCLUSION: Review of toxicologic data on glutaraldehyde shows this is a highly irritating chemical for the respiratory tract, even at low concentrations. Clinical and radiologic features in these three neonates are compatible with a pulmonary sub-edema on an immature alveolar setting. The hypothesis proposed is that glutaraldehyde, the active ingredient of the biocidal formula used to disinfect the respiratory masks, was massively desorbed from the rubber and foam of which masks are made.

[Occupational toxic exposure in the pregnant woman. 1: principles fo individual risk assessment ]. / Exposition toxique professionnelle chez la femme enceinte. 1re Partie: Principes de l'évaluation du risque individuel.

CONTEXT: Many women of childbearing age are occupationally exposed to chemicals and concerned with the ensuing risk when pregnant. OBJECTIVES: To describe the principles of individual risk assessment to be applied in pregnant women or women wishing to become pregnant that are exposed to chemicals at the workplace. METHOD: Each request for risk assessment is based on a comprehensive review of the hazards of the handled products together with a thorough evaluation of the actual exposure at the workplace. A toxicological advice is then written to the gynecologist or the general practitioner in charge of the patient. When the exposure is estimated to be hazardous for the pregnancy, either total withdrawal, avoidance of certain activities or improvements of individual protective devices are recommended. The outcome of the pregnancy is systematically followed-up. CONCLUSION: An objective assessment of toxic risks in pregnant women exposed to chemicals at the workplace can be done. Thus, patients who must be withdrawn or benefit from improvements of their workstation can be selected.

[Occupational toxic exposure and the pregnant woman. 2: results of a prospective study of 100 pregnancies]. / Exposition toxique professionnelle chez la femme enceinte. 2e Partie: Résultats du suivi prospectif de 100 grossesses.

CONTEXT: Many women of childbearing age are occupationally exposed to chemicals and concerned with the ensuing risk when pregnant. OBJECTIVES: To present the results of a prospective follow-up study of 100 pregnant women and to discuss them after a brief overview of the published data on this topic. METHODS: Since January 1996 the Lyon Poison Center has been conducting a prospective follow-up of all request concerning pregnant women occupationally exposed to chemicals. A thorough evaluation of the hazards of the handled products and of the actual exposure at the workplace is done for each patient. A toxicological advice is given and the outcome of the pregnancy is followed-up. RESULTS: One hundred pregnant women were included between January 1996 and December 2000. Based on the nature of the handled products, two groups have been identified: the first included 73 women exposed to organic solvents and the second 27 women exposed to miscellaneous. When the exposure was considered potentially hazardous for the pregnancy, either withdrawal from the workstation (19 cases), avoidance of certain activities (9 cases) or improvement of individual protective measures (29 cases) was recommended. In 43% of the cases, the occupational exposure was not considered hazardous to the outcome of the pregnancy. No increase of adverse outcome was identified: 4 miscarriages and 96 living births were observed, with 2 major malformations and 1 minor malformation. CONCLUSION: Occupational exposure to chemicals was not found to affect adversely the outcome of these 100 pregnancies.

[Respiratory manifestations after exposure to sulfurous anhydride in wine-cellar workers: 6 case reports]. / Manifestations respiratoires dues à l'anhydride sulfureux en cave de vinification: 6 observations.

Sulfite treatment of wine [a process exploiting the biocidal and anti-oxidant properties of sulfur dioxide (SO2)] involves the use of liquified gas, aqueous solutions or bisulfites, i.e. the salts of sulfurous acid which slowly release SO2. This procedure can result in repeated exposures of operators to significant amounts of SO2. However, risks associated with the use of SO2 are greatly under-estimated by wine producers and wine-cellar workers. We report on 6 cases of respiratory symptoms attributable to SO2 identified during a survey of wine-cellars in the French Beaujolais district. Their pathogenesis is discussed after an overview of the occupational toxicology of SO2.

[Reactive airway dysfunction syndrome: more flexible application of diagnostic criteria are important for occupational accident victims]. / Syndrome de Brooks: pour plus de souplesse dans l'application des critères diagnostiques.

Reactive airway dysfunction syndrome (RADS), or Brooks syndrome, is a complication observed after inhalation of caustic or highly irritating substances. The diagnosis is based on a group of criteria which include the absence of prior respiratory disease. Strict application of these criteria could have a prejudicial effect for certain victims. Three serious cases of RADS were observed in workers who were exposed to massive inhalation of caustic substances. The products implicated (phosphoric oxychloride, titanium tetrachloride, and trichloroacetyl chloride) hydrolyze to hydrochloric acid when they come in contact with the airway mucosa. After an initial period of acute respiratory distress, the patients encountered serious difficulties in achieving an appropriate diagnosis, and in having their sequellae recognized as resulting from an occupational accident. The problem was that these patients had a history of cured allergic asthma or smoking-related COPD. The presence of prior respiratory disorders must not exclude the diagnosis of RADS. A prior respiratory disorder cannot be used as an argument to exclude such victims from indemnities for occupational accident sequelae.

[Environmental lead poisoning from lead-glazed earthenware used for storing drinks]. / Intoxication environnementale par le plomb liée à la consommation de boisson conservée dans une cruche artisanale en céramique vernissée.

INTRODUCTION: Current unusual environmental sources of lead exposure mainly include traditional medicines, either ayurvedic remedies or others, traditional cosmetics (kohl, surma), and the use of traditional earthenware, for storage or cooking. CASE REPORTS: We report two cases of lead poisoning in adults initially identified by paroxysmal abdominal pain or anemia. In both cases, the environmental investigation evidenced one main source of lead exposure, namely a lead-glazed earthenware jug in which a drink was stored, "kefir" in the first case, and "kombucha" tea in the second one. CONCLUSION: It is recommended to search for lead intoxication in patients with unexplained anemia. Environmental sources of lead can be multiple. Their relative importance has to be ranked during the environmental investigation and among these, lead-glazed earthenware must be considered as a source of high lead exposure when drinks are stored inside and thus can soak.

Acute hexogen poisoning after occupational exposure.

BACKGROUND: Hexogen (cyclonite, RDX) nitrate explosive is an infrequent cause of poisoning. CASE REPORT: A 42-year-old man with no prior history of epilepsy experienced grand mal seizures after sieving fine hexogen (RDX) powder for four hours in an ammunition plant. Physical examination was normal on arrival at the emergency room but recurrent seizures occurred six hour after admission. EEG, CT scan and MRI were normal and the patient recovered uneventfully. CONCLUSIONS: The available toxicological data on this rare occupational poisoning are reviewed.