RESUMO
OBJECTIVE: To evaluate the efficiency of a radiomics model in predicting the prognosis of patients with acute paraquat poisoning (APP). MATERIALS AND METHODS: Chest computed tomography images and clinical data of 80 patients with APP were obtained from November 2014 to October 2017, which were randomly assigned to a primary group and a validation group by a ratio of 7 : 3, and then the radiomics features were extracted from the whole lung. Principal component analysis (PCA) and least absolute shrinkage and selection operator (LASSO) regression were used to select the features and establish the radiomics signature (Rad-score). Multivariate logistic regression analysis was used to establish a radiomics prediction model incorporating the Rad-score and clinical risk factors; the model was represented by nomogram. The performance of the nomogram was confirmed by its discrimination and calibration. RESULT: The area under the ROC curve of operation was 0.942 and 0.865, respectively, in the primary and validation datasets. The sensitivity and specificity were 0.864 and 0.914 and 0.778 and 0.929, and the prediction accuracy rates were 89.5% and 87%, respectively. Predictors included in the individualized predictive nomograms include the Rad-score, blood paraquat concentration, creatine kinase, and serum creatinine. The AUC of the nomogram was 0.973 and 0.944 in the primary and validation datasets, and the sensitivity and specificity were 0.943 and 0.955, respectively, in the primary dataset and 0.889 and 0.929 in the validation dataset, and the prediction accuracy was 94.7% and 91.3%, respectively. CONCLUSION: The radiomics nomogram incorporates the radiomics signature and hematological laboratory data, which can be conveniently used to facilitate the individualized prediction of the prognosis of APP patients.
Assuntos
Paraquat/intoxicação , Intoxicação/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nomogramas , Intoxicação/epidemiologia , Intoxicação/patologia , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
BACKGROUND: Basal ganglia lesions are typical findings on magnetic resonance imaging (MRI) of the brain in survivors of acute methanol poisoning. However, no data are available on the association between the magnitude of damaged brain regions, serum concentrations of markers of acute methanol toxicity, oxidative stress, neuroinflammation, and the rate of retinal nerve ganglion cell loss. OBJECTIVES: To investigate the association between MRI-based volumetry of the basal ganglia, retinal nerve fibre layer (RNFL) thickness and prognostic laboratory markers of outcomes in acute methanol poisoning. METHODS: MRI-based volumetry of putamen, nucleus caudatus and globus pallidus was performed and compared with laboratory parameters of severity of poisoning and acute serum markers of oxidative damage of lipids (8-isoprostan, MDA, HHE, HNE), nucleic acids (8-OHdG, 8-OHG, 5-OHMU), proteins (o-Thyr, NO-Thyr, Cl-Thyr) and leukotrienes (LTC4, LTD4, LTE4, LTB4), as well as with the results of RNFL measurements by optic coherence tomography (OCT) in 16 patients with acute methanol poisoning (Group I) and in 28 survivors of poisoning two years after discharge with the same markers measured within the follow-up examination (Group II). The control group consisted of 28 healthy subjects without methanol poisoning. RESULTS: The survivors of acute methanol poisoning had significantly lower volumes of basal ganglia than the controls. The patients with MRI signs of methanol-induced toxic brain damage had significantly lower volumes of basal ganglia than those without these signs. A positive correlation was found between the volume of putamen and arterial blood pH on admission (r = 0.45; p = 0.02 and r = 0.44; p = 0.02 for left and right putamen, correspondingly). A negative correlation was present between the volumes of putamen and acute serum lactate (r = -0.63; p < 0.001 and r = -0.59; p = 0.01), creatinine (r = -0.53; p = 0.01 and r = -0.47; p = 0.01) and glucose (r = -0.55; p < 0.001 and r = -0.50; p = 0.01) concentrations. The volume of basal ganglia positively correlated with acute concentrations of markers of lipoperoxidation (8-isoprostan: r = 0.61; p < 0.05 and r = 0.59; p < 0.05 for left and right putamen, correspondingly) and inflammation (leukotriene LTB4: r = 0.61; p < 0.05 and r = 0.61; p < 0.05 for left and right putamen, correspondingly). The higher the volume of the basal ganglia, the higher the thickness of the RNFL, with the strongest positive association between global RNFL and the volume of putamen bilaterally (all p < 0.01). In the follow-up markers of oxidative stress and inflammation, only o-Thyr concentration negatively correlated with the volume of putamen bilaterally (r = -0.39; p < 0.05 and r = -0.37; p < 0.05 for left and right putamen, correspondingly). CONCLUSION: In survivors of acute methanol poisoning with signs of toxic brain damage, the magnitude of affected areas correlated with acute parameters of severity of poisoning, markers of oxidative stress and neuroinflammation. There was a positive association between the basal ganglia volume and the thickness of RNFL, making OCT an important screening test and MRI-based volumetry the confirmative diagnostic method for the detection of CNS sequelae of methanol poisoning.
Assuntos
Gânglios da Base/diagnóstico por imagem , Imageamento por Ressonância Magnética , Metanol/intoxicação , Intoxicação/diagnóstico por imagem , Retina/diagnóstico por imagem , Tomografia de Coerência Óptica , Adulto , Gânglios da Base/efeitos dos fármacos , Gânglios da Base/metabolismo , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Mediadores da Inflamação/sangue , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/efeitos dos fármacos , Tamanho do Órgão , Estresse Oxidativo , Intoxicação/sangue , Valor Preditivo dos Testes , Retina/efeitos dos fármacos , Retina/metabolismo , Índice de Gravidade de DoençaRESUMO
Bromoform ingestion and toxicity is a rare finding. Historically, bromoform was therapeutically prescribed as a sedative in whooping cough, and accidental overdoses occurred mainly in children. Bromoform is used in various industries. In the twenty-first century, bromoform ingestion can occur in the form of chlorinated water such as in pools and drinking water. We present a case report where the initial history and circumstances of death were unknown. A pre-autopsy full-body X-ray image using the Lodox® Xmplar-dr scanner revealed a dense radiopaque material in the stomach and intestines. This radiological finding proved vital in the approach and subsequent follow-up of the case.
Assuntos
Trato Gastrointestinal/diagnóstico por imagem , Intoxicação/diagnóstico por imagem , Radiografia/instrumentação , Imagem Corporal Total/métodos , Adulto , Autopsia , Humanos , Masculino , Trialometanos/intoxicaçãoRESUMO
Background: Aluminum and zinc phosphides are solid fumigants for pest control. Metal phosphide poisoning (PP) is common in suicide and suicide attempts. In Mexico, zinc phosphide is easily available, and is a common agent in poisonings. Objective: To identify mortality in PP, and associated factors in a poison control center. Material and methods: Prospective cohort study. The starting point was the exposure (PP) and it was made a follow-up on the outcome (mortality and non-mortality). Main factors associated to PP outcome were assessed (e.g.: personal and clinical factors, duration of poisoning, detoxification, and radiographic evidence of poisoning). It was used relative risk (RR) as a risk estimator with 95% CI, as well as chi-squared with Fisher's exact test, Kaplan-Meier survival curves, and Log- Rank test as a comparative mean. Results: 44 exposed patients, and 88 non-exposed were followed up. Mortality rate in PP was of 16% in acute phase patients; there were no deaths in either subacute or chronic phases. Mortality risk was 14 (95% CI, 2 110). Main factors associated with increased mortality were: time of first medical assistance > 6 hours, RR = 15 (95% CI, 1.7-128); dose of poison ≥ 1 bottle or 1 tablet, RR = 14 (95% CI, 1.8-108); radiographic evidence of poisoning, RR = 10 (95% CI, 1.3 77). Conclusion: Metal PP has a high mortality rate and is associated to long periods of exposure to the toxic chemical due to ineffective detoxification.
Introducción: los fosfuros de aluminio y zinc son fumigantes sólidos para controlar plagas. La intoxicación por fosfuros (IpF) es un método común en suicidios o intentos de suicidio. En México los fosfuros son de fácil distribución y son un agente común en las intoxicaciones. Objetivo: identificar la mortalidad en la IpF y los factores asociados en un centro de toxicología. Material y métodos: estudio de cohorte prospectiva. Se partió de la exposición (IpF) y se siguió el desenlace (mortalidad y no mortalidad). Se evaluaron los principales factores asociados al desenlace de IpF (por ejemplo: clínicos, personales, tiempo de la intoxicación, descontaminación y evidencia radiográfica). Para estimar el riesgo se empleó el riesgo relativo (RR), con IC al 95%, chi cuadrada con prueba exacta de Fisher, curvas de supervivencia de Kaplan-Meier y su comparación por medio de Log-Rank. Resultados: se siguieron 44 pacientes expuestos y 88 no expuestos. La mortalidad por fosfuros fue del 16% de los pacientes intoxicados en la fase aguda; no hubo mortalidad en la fase subaguda y crónica. El riesgo de mortalidad fue de 14 (IC 95%: 2-110). Los factores de mayor magnitud asociados a la mortalidad en la IpF fueron: tiempo de primera atención > 6 horas, RR = 15 (IC 95% 1.7 128); dosis del tóxico ≥ 1 frasco o 1 pastilla, RR = 14 (IC 95%: 1.8 108); evidencia radiográfica del tóxico RR = 10, (IC 95%: 1.3 77). Conclusiones: la intoxicación por fosfuros metálicos tiene alta mortalidad y está asociada a estados prolongados de exposición al tóxico por descontaminación inadecuada.
Assuntos
Compostos de Alumínio/intoxicação , Praguicidas/intoxicação , Fosfinas/intoxicação , Rodenticidas/intoxicação , Compostos de Zinco/intoxicação , Doença Aguda , Adolescente , Adulto , Idoso , Criança , Doença Crônica , Intervalos de Confiança , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Estimativa de Kaplan-Meier , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Intoxicação/diagnóstico por imagem , Intoxicação/mortalidade , Estudos Prospectivos , Risco , Fatores de Tempo , Adulto JovemRESUMO
Synthetic marijuana is a dangerous substance due to its potency, ever-changing composition, and unpredictable side effects. Recently, brodifacoum-contaminated synthetic marijuana has led to multiple deaths and morbidity throughout the USA from severe coagulopathy associated with use of this strain of the drug (brodifacoum is a rodenticide and potent Vitamin K antagonist/anticoagulant). We describe the clinical and radiologic findings in two patients who were diagnosed with, and treated for, ingestion of this new strain of synthetic marijuana. The radiologic manifestations were most notable for hemorrhagic pyelitis/ureteritis. Both patients required hospitalization with Vitamin K supplementation. The radiologic and clinical pictures in these patients are important for radiologists to recognize in order to help guide appropriate patient management.
Assuntos
4-Hidroxicumarinas/intoxicação , Transtornos da Coagulação Sanguínea/induzido quimicamente , Transtornos da Coagulação Sanguínea/diagnóstico por imagem , Canabinoides/intoxicação , Surtos de Doenças , Drogas Ilícitas/intoxicação , Intoxicação/diagnóstico por imagem , Rodenticidas/intoxicação , Adulto , Baltimore/epidemiologia , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intoxicação/tratamento farmacológico , Tomografia Computadorizada por Raios X , Vitamina K/uso terapêuticoRESUMO
Suicide is the eighth cause of mortality in France and the leading cause in people aged between 25 and 34 years. The most common methods of suicide are hanging, self-poisoning with medicines and firearms. Postmortem computed tomography (CT) is a useful adjunct to autopsy to confirm suicide and exclude other causes of death. At autopsy, fractures of the hyoid bone or thyroid cartilage, or both, are found in more than 50% of suicidal hangings. Cervical vertebra fractures are rare and only seen in suicide victims jumping from a great height. Three-dimensional reconstructions from CT data are useful to visualize the ligature mark on the neck. In suicides by firearm, postmortem CT shows entry and exit wounds, parenchymal lesions along the bullet path, as well as projectiles in case of penetrating trauma. However, in the chest and abdomen it is more difficult to identify the path of the projectile. Postmortem CT also shows specific features of suicide by drowning or stabbing, but its use is limited in cases of self-poisoning. The use of postmortem CT is also limited by decomposition and change of body position. This article presents the imaging features seen on postmortem CT according to the method of suicide.
Assuntos
Autopsia/métodos , Suicídio , Tomografia Computadorizada por Raios X , Asfixia/diagnóstico por imagem , Afogamento/diagnóstico por imagem , Patologia Legal , Conteúdo Gastrointestinal/diagnóstico por imagem , Humanos , Pulmão/diagnóstico por imagem , Lesões do Pescoço/diagnóstico por imagem , Intoxicação/diagnóstico por imagem , Ferimentos por Arma de Fogo/diagnóstico por imagem , Ferimentos Perfurantes/diagnóstico por imagemRESUMO
Abstract Background and objectives: To evaluate the thermographic predictive value of local anesthetic poisoning in rats that indicates the early recognition of thermal signs of intoxication and enable the immediate start of advanced life support. Methods: Wistar rats underwent intraperitoneal injection of saline and ropivacaine; they were allocated into pairs, and experiments performed at baseline and experimental times. For thermography, central and peripheral compartment were analyzed, checking the maximum and average differences of temperatures between groups. Thermographic and clinical observations were performed for each experiment, and the times in which the signs of intoxication occurred were recorded. In the thermal analysis, the thermograms corresponding to the times of interest were sought and relevant data sheets extracted for statistical analysis. Results: Basal and experimental: the display of the thermal images at times was possible. It was possible to calculate the heat transfer rate in all cases. At baseline it was possible to see the physiology of microcirculation, characterized by thermal distribution in the craniocaudal direction. It was possible to visualize the pathophysiological changes or thermal dysautonomias caused by intoxication before clinical signs occur, characterized by areas of hyper-radiation, translating autonomic nervous system pathophysiological disorders. In animals poisoned by ropivacaine, there was no statistically significant difference in heat transfer rate at the experimental time. Conclusions: The maximum temperature, medium temperature, and heat transfer rate were different from the statistical point of view between groups at the experimental time, thus confirming the systemic thermographic predictive value.
Resumo Justificativa e objetivos: Estudar o valor preditivo termográfico na intoxicação por anestésico local em ratos que efetue o reconhecimento precoce dos sinais térmicos de intoxicação e possibilite o início imediato do suporte avançado de vida. Método: Ratos Wistar foram submetidos à injeção intraperitoneal de soro fisiológico e ropivacaína, alocados aos pares, e foram feitos experimentos em tempos basal e experimental. Para o estudo termodinâmico foram analisados o compartimento central e o periférico, verificaram-se as diferenças das temperaturas máximas e médias entre os grupos. Foram feitas observações clínicas e termográficas para cada experimento e anotados os tempos em que os sinais de intoxicação ocorriam. Foram buscados na análise termográfica os termogramas correspondentes aos tempos de interesse e extraídas as planilhas de dados correspondentes, para análise estatística. Resultados: Foi possível a visibilização das imagens térmicas nos momentos basal e experimental. Foi possível calcular a taxa de transferência de calor em todos os casos. No momento basal foi possível observar a fisiologia da microcirculação, caracterizada por distribuição térmica no sentido craniocaudal. Foi possível visibilizar as alterações fisiopatológicas ou disautonomias térmicas causadas pela intoxicação antes que os sinais clínicos ocorressem, caracterizadas por áreas de hiperradiação e traduziram perturbações fisiopatológicas do Sistema Nervoso Autônomo. Nos animais intoxicados por ropivacaína houve diferença estatisticamente significativa na taxa de transferência de calor no momento experimental. Conclusões: Constatou-se que a temperatura máxima, a temperatura média e a taxa de transferência de calor foram diferentes do ponto de vista estatístico entre os grupos no momento experimental, o que corrobora o valor preditivo termográfico sistêmico.
Assuntos
Animais , Masculino , Ratos , Intoxicação/diagnóstico por imagem , Anestésicos Locais/intoxicação , Termografia , Ratos Wistar , Ropivacaina , Amidas/intoxicação , Raios InfravermelhosRESUMO
BACKGROUND AND OBJECTIVES: To evaluate the thermographic predictive value of local anesthetic poisoning in rats that indicates the early recognition of thermal signs of intoxication and enable the immediate start of advanced life support. METHODS: Wistar rats underwent intraperitoneal injection of saline and ropivacaine; they were allocated into pairs, and experiments performed at baseline and experimental times. For thermography, central and peripheral compartment were analyzed, checking the maximum and average differences of temperatures between groups. Thermographic and clinical observations were performed for each experiment, and the times in which the signs of intoxication occurred were recorded. In the thermal analysis, the thermograms corresponding to the times of interest were sought and relevant data sheets extracted for statistical analysis. RESULTS: Basal and experimental: the display of the thermal images at times was possible. It was possible to calculate the heat transfer rate in all cases. At baseline it was possible to see the physiology of microcirculation, characterized by thermal distribution in the craniocaudal direction. It was possible to visualize the pathophysiological changes or thermal dysautonomias caused by intoxication before clinical signs occur, characterized by areas of hyper-radiation, translating autonomic nervous system pathophysiological disorders. In animals poisoned by ropivacaine, there was no statistically significant difference in heat transfer rate at the experimental time. CONCLUSIONS: The maximum temperature, medium temperature, and heat transfer rate were different from the statistical point of view between groups at the experimental time, thus confirming the systemic thermographic predictive value.
Assuntos
Anestésicos Locais/intoxicação , Intoxicação/diagnóstico por imagem , Amidas/intoxicação , Animais , Raios Infravermelhos , Masculino , Ratos , Ratos Wistar , Ropivacaina , TermografiaRESUMO
CONTEXT: In paraquat (PQ) poisoning, death often occurs after the appearance of pneumomediastinum (PM). However, the clinical features and eventual outcome of PM in PQ intoxication remains unclear. OBJECTIVE: We aimed to characterize PM following PQ poisoning and its prognostic value for predicting mortality. MATERIALS AND METHODS: Enrolled PQ-poisoned patients (n = 75) were divided into two groups according to whether PM could be detected by chest computed tomography or not. The study outcomes included 5- and 90-day death after intoxication. Survival curves were derived using the Kaplan-Meier method, and mortality risk factors were analyzed by forward stepwise Cox regression analysis. RESULTS: PM was documented in 21.3% of the patients (16/75); in 13 of them PM set in within 3 days of PQ ingestion. 15 patients died within 3 days of appearance of PM. Compared with patients without PM, those with PM were younger (P = 0.011), and had higher scores of Acute Physiology and Chronic Health Evaluation (P < 0.001) and Sequential Organ Failure Assessment (P = 0.003). In addition, patients with PM had a higher incidence of acute renal failure (P = 0.001), toxic hepatitis (P = 0.008), and respiratory insufficiency (P = 0.003). PM predicted an increased risk of 90-day death (93.8% of patients with PM vs. 40.7% among those without PM; hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.0-5.6; P = 0.045), and increased risk of 5-day death (81.3% vs. 27.1%; HR, 3.2; 95% CI, 1.2-8.1; P = 0.017). DISCUSSION AND CONCLUSION: Early PM, occurring within 8 days, is a specific predictor of mortality in PQ poisoning.
Assuntos
Herbicidas/intoxicação , Enfisema Mediastínico/induzido quimicamente , Enfisema Mediastínico/mortalidade , Paraquat/intoxicação , Intoxicação/mortalidade , APACHE , Doença Aguda , Adulto , Distribuição de Qui-Quadrado , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Escores de Disfunção Orgânica , Intoxicação/diagnóstico por imagem , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
AIM: To evaluate the clinical features of zinc phosphide poisoning and to investigate whether outcome could be prognosticated based on abdominal radiography on presentation. MATERIALS AND METHODS: All zinc phosphide-poisoned patients who were referred to Loghman-Hakim Hospital between March 2011 and September 2013 were retrospectively reviewed. Data regarding patients' demographic characteristics, characteristics of the poisoning, abdominal radiography results, and patients' outcome were recorded. RESULTS: In 102 patients, the most common presenting signs/symptoms were nausea and vomiting (60%). Four patients died and another seven had developed complications during their hospitalization (metabolic acidosis, liver abnormalities, or acute renal failure). Nineteen patients had radio-opaque abdominal radiographs, nine of whom had died or developed complications (p = 0.001). Plain abdominal radiography had a sensitivity and specificity of 81% and 89% in predicting the patients' death or further development of complications. The positive and negative predictive values were 47% and 97%, respectively. CONCLUSION: Plain abdominal radiography is a very good tool for prognostication in patients with zinc phosphide poisoning. Immediate abdominal radiography can help stratify patients into high- or low-risk groups and determine treatment strategies.
Assuntos
Fosfinas/intoxicação , Intoxicação/diagnóstico por imagem , Radiografia Abdominal/métodos , Rodenticidas/intoxicação , Compostos de Zinco/intoxicação , Acidose/induzido quimicamente , Acidose/mortalidade , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/mortalidade , Adolescente , Adulto , Idoso , Doença Hepática Induzida por Substâncias e Drogas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intoxicação/complicações , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento , Adulto JovemRESUMO
Fatal acute methamphetamine (MA) poisoning in cases of internal drug trafficking is rarely described in the literature. This case study reports an MA 'body packer' who died from fatal methamphetamine intoxication due to leaking drug packages in the alimentary tract. The deceased was examined by postmortem computed tomography (PMCT), and the results were correlated to subsequent autopsy and toxicological findings. The deceased was arrested by the police when he was found disoriented in the city of Kuala Lumpur. He was transferred to the emergency department on suspicion of drug abuse. The initial drug screening was reactive for amphetamines. Shortly after admission to the hospital, he died despite rigorous resuscitation attempts. The postmortem plain chest and abdominal radiographs revealed multiple suspicious opacities in the gastrointestinal tract attributable to body packages. An unenhanced whole body PMCT revealed twenty-five drug packages, twenty-four in the stomach and one in the transverse colon. At least two were disintegrating, and therefore leaking. The autopsy findings were consistent with the PMCT results. Toxicology confirmed the diagnosis of fatal methamphetamine intoxication.
Assuntos
Crime , Corpos Estranhos/diagnóstico por imagem , Medicina Legal/métodos , Trato Gastrointestinal/diagnóstico por imagem , Drogas Ilícitas/intoxicação , Metanfetamina/intoxicação , Tomografia Computadorizada Multidetectores , Adulto , Autopsia , Causas de Morte , Embalagem de Medicamentos , Evolução Fatal , Toxicologia Forense , Trato Gastrointestinal/metabolismo , Humanos , Drogas Ilícitas/sangue , Absorção Intestinal , Masculino , Metanfetamina/sangue , Intoxicação/sangue , Intoxicação/diagnóstico por imagem , Intoxicação/patologia , Valor Preditivo dos Testes , Reprodutibilidade dos TestesRESUMO
In the patients with medication poisoning, diagnosis and treatment may be complicated due to the decreased level of consciousness or lack of the patient cooperation. In this review, we tried to assess the role of ultrasonography in detection of the ingested medication in the stomach of the patients with suspected medication poisoning. Of the studies performed in this regard, only one managed to determine the extended phenytoin capsules in the stomach of a poisoned patient. In actual acute poisoning - even in the hands of an experienced ultrasonographer - detection of the medications in the patients' stomach seems to be difficult due to the presence of the food or lack of the water in their stomach. Also, after dissolution of the tablets or capsules or their passage from the pylorus, they can not further been visualized by ultrasound. We, therefore, conclude that ultrasonography is not an appropriate tool for diagnosis of the medication ingestion in acute poisoning.
Assuntos
Intoxicação/diagnóstico por imagem , Doença Aguda , Humanos , UltrassonografiaRESUMO
INTRODUCTION: Following acute organophosphate exposure, morphological changes in certain regions of the brain have been reported to develop within a few hours and involve neuronal degeneration. Single photon emission computed tomography (SPECT) has been used to determine changes in the regional cerebral blood flow and attempts have been made to correlate these changes with long-term neurological sequelae. PURPOSE OF STUDY: The aim of the study was to determine changes in the regional cerebral blood flow by 99mTc-ECD SPECT following acute organophosphate poisoning and to correlate these defects with abnormalities in neurocognitive testing carried out during admission and at 3 months post exposure, in order to determine whether any changes in the cerebral blood flow could help in predicting future development of neurocognitive deficit. PATIENTS AND METHODS: Twenty-eight patients with acute organophosphorous poisoning were included in the study. The inclusion criteria were a history of ingestion or accidental exposure, clinical features of cholinergic crises, and low serum acetylcholinesterase (AChE). Twenty age- and sex-matched patients from a previous study were used as controls for the neurocognitive tests. There were no controls for SPECT. RESULTS: Of the 28 patients studied, 27 had abnormalities in the regional cerebral blood flow on SPECT with men having significantly higher abnormalities than women (p < 0.05). The right side of the brain had more defects than the left, with the occipital lobes being the most commonly involved. Of seven neurocognitive function tests carried out on patients who had regional cerebral blood flow defects during admission, abnormalities were observed in six tests. In 18 of 26 patients who could be tested at 3 months post exposure, improvement was observed in Trail B and Visual retention tests. However, others tests remained significantly abnormal. CONCLUSION: We conclude that a single episode of clinically significant organophosphate intoxication can lead to persistent residual neurocognitive deficits. Detection of regional cerebral blood flow defects on 99mTc-ECD SPECT can possibly help in predicting long-term deficits in neurocognitive functions in such patients.
Assuntos
Circulação Cerebrovascular/efeitos dos fármacos , Transtornos Cognitivos/induzido quimicamente , Transtornos Cognitivos/psicologia , Intoxicação por Organofosfatos , Intoxicação/diagnóstico por imagem , Intoxicação/psicologia , Doença Aguda , Adolescente , Adulto , Encéfalo/diagnóstico por imagem , Antagonistas Colinérgicos/intoxicação , Cisteína/análogos & derivados , Feminino , Humanos , Inseticidas/intoxicação , Masculino , Memória/efeitos dos fármacos , Pessoa de Meia-Idade , Testes Neuropsicológicos , Compostos de Organotecnécio , Desempenho Psicomotor/efeitos dos fármacos , Compostos Radiofarmacêuticos , Reconhecimento Psicológico/efeitos dos fármacos , Tentativa de Suicídio , Tomografia Computadorizada de Emissão de Fóton Único , Teste de Sequência Alfanumérica , Comportamento Verbal/efeitos dos fármacos , Adulto JovemAssuntos
Encéfalo/efeitos dos fármacos , Encéfalo/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Imageamento por Ressonância Magnética , Metanol/intoxicação , Tomografia Computadorizada por Raios X , Adulto , Hemorragia Cerebral/induzido quimicamente , Formaldeído/metabolismo , Formaldeído/toxicidade , Formiatos/metabolismo , Formiatos/toxicidade , Humanos , Masculino , Metanol/metabolismo , Necrose/diagnóstico por imagem , Intoxicação/diagnóstico por imagem , Intoxicação/metabolismo , Putamen/diagnóstico por imagem , Putamen/efeitos dos fármacos , Tentativa de Suicídio , Fatores de TempoRESUMO
OBJECTIVE: To evaluate the right ventricular functions of patients with acute organophosphate poisoning patient (AOPP) by measuring the velocities of tricuspid annular motion through Doppler tissue imaging (DTI). METHODS: Tissue Doppler velocity mode was employed to observe tricuspid annulus movement in 78 AOPP patients and 32 healthy adults. After tricuspid annular pulsed-wave rate of E/A were measured by traditional echocardiographic, the peak values of tricuspid annular early diastolic velocity (E(m)) and late diastolic velocity (A(m)) were analyzed by DTI. RESULTS: E/A > E(m)/A(m) > 1 was observed in health control group as well as the mild-moderate AOPP; E(m)/A(m) < E/A < 1 was observed in the severe AOPP group. There was significant difference between two groups. The right ventricular E/A correlated positively with E(m)/A(m) (P < 0.001). Pulmonary arterial pressure (PAP) correlated positively with right ventricular E/Em, Tei Index (P < 0.001) and negatively with right ventricular S(m), E(m) and E(m)/A(m) (P < 0.001). CONCLUSION: The right ventricle functions, in terms of contraction and relaxation, decrease in severe AOPP patients versus health control and mild-moderate groups. TDI is a useful tool to assess the right ventricle functions of AOPP patients.
Assuntos
Intoxicação por Organofosfatos , Intoxicação/diagnóstico por imagem , Intoxicação/fisiopatologia , Função Ventricular Direita , Adulto , Idoso , Estudos de Casos e Controles , Ecocardiografia Doppler em Cores , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Praguicidas/intoxicaçãoRESUMO
Paraquat is a nonselective contact herbicide of great toxicological importance, being associated with high mortality rates, mainly due to respiratory failure. We report the case of a 22-year-old male admitted to the emergency room with a sore throat, dysphagia, hemoptysis, and retrosternal pain after the ingestion of 50 mL of a paraquat solution, four days prior to admission. Chest CT scans revealed pulmonary opacities, pneumomediastinum, pneumothorax, and subcutaneous emphysema. The patient was submitted to two cycles of immunosuppressive therapy with cyclophosphamide, methylprednisolone, and dexamethasone. The pulmonary gas exchange parameters gradually improved, and the patient was discharged four weeks later. The clinical and tomographic follow-up evaluations performed at four months after discharge showed that there had been further clinical improvement. We also present a brief review of the literature, as well as a discussion of the therapeutic algorithm for severe paraquat poisoning.
Assuntos
Pulmão/diagnóstico por imagem , Paraquat/intoxicação , Humanos , Masculino , Intoxicação/diagnóstico por imagem , Radiografia , Tentativa de Suicídio , Adulto JovemAssuntos
Intestinos , Cloreto de Potássio/intoxicação , Adulto , Cápsulas , Feminino , Humanos , Intestinos/diagnóstico por imagem , Intoxicação/sangue , Intoxicação/diagnóstico por imagem , Intoxicação/terapia , Cloreto de Potássio/administração & dosagem , Cloreto de Potássio/sangue , Radiografia , Tentativa de Suicídio , Irrigação TerapêuticaRESUMO
Abdominal computed tomography aids in the evaluation of the conditions in the stomach and will decrease needless gastric lavage in acute poisoning patients. A 16-year-old girl with a history of schizophrenia with depressive disorder was taken to our hospital. Her Glasgow Coma Scale was 8. Symptoms related to anticholinergic effects were strongly present. Her electrocardiogram showed sinus tachycardia with 60 milliseconds of QRS duration. Computed tomography images showed that the patient had a large amount of debris derived from tablets in her stomach and duodenum. We performed gastric aspiration through a nasogastric tube and not gastric lavage, and it took 5 minutes to complete the procedure. We administered activated charcoal 3 times. Intubation was not performed. Other than tonic-clonic seizure that was observed once, neither cardiovascular nor neurologic symptoms were observed. She recovered fully and admitted that she had ingested more than a hundred tablets almost 10 hours before being brought to our hospital. Computed tomography images show a cluster of tablets and debris to be of a higher density than tissues; this allows quantitative and qualitative evaluations to be performed. We were able to treat the patient with effective use of nasogastric tube.