A. Villa

Evaluation of environmental contamination by platinum and exposure risks for healthcare workers during a heated intraperitoneal perioperative chemotherapy (HIPEC) procedure

The study was plan to assess platinum (Pt) contamination in the operating room and its exposure to health workers during heated intraperitoneal perioperative chemotherapy (HIPEC) using oxaliplatin.

Evaluation of oxaliplatin exposure of healthcare workers during heated intraperitoneal perioperative chemotherapy (HIPEC)

The aim of this study was to evaluate air and surface contaminations, and internal contamination of healthcare workers during open-abdomen HIPEC using oxaliplatin. Platinum (Pt) was measured in urine of exposed workers and in multiple air and surface samples. Three successive HIPEC procedures were investigated in each of the two hospitals participating in the study. Analysis of air samples did not detect any oxaliplatin contamination. Heavy contamination of the operating table, the floor at the surgeon’s feet, and the surgeon’s overshoes were observed. Hand contamination was observed in surgeons using double gloves for intra-abdominal chemotherapy administration, but not in those using three sets of gloves. Pt was not detected in urine samples obtained after HIPEC (<5 ng/L). The main risk of HIPEC is related to direct or indirect skin exposure and can be prevented by correct use of adapted protective equipment.

Occupational rhinitis and asthma due to EDTA-containing detergents or disinfectants.

BACKGROUND Detergents and disinfectants are an emerging cause of work-related rhinitis and asthma. These products may contain ethylenediamine tetraacetic acid (EDTA). The authors report 10 cases of EDTA-related asthma and/or rhinitis. METHODS Review of the medical charts of patients who presented with work-related rhinitis (alone or with asthma), with a history of exposure to aerosols of EDTA-containing products and who underwent a nasal provocation test (NPT) with tetrasodium EDTA (1-4%) in our occupational health unit. RESULTS Twenty-eight patients underwent a NPT with EDTA, which was positive in 10 cases. These patients, mostly cleaners or healthcare workers, used spray formulations of cleaning products. CONCLUSIONS This case series is the first report of EDTA-related respiratory disease, documented by a specific test. An irritant mechanism is unlikely. Further studies are required to distinguish between an immunoallergic response and a pharmacological mechanism possibly resulting from calcium chelation, as suggested by animal experiments. A ban of spray preparations would be sufficient to prevent respiratory disease induced by EDTA inhalation, regardless of its mechanism.

Dimethylformamide metabolism following self-harm using a veterinary euthanasia product.

Background. A veterinary euthanasia drug containing embutramide, mebezonium, tetracaine, and dimethylformamide (DMF; T-61® or Tanax®) may cause serious manifestations or even fatalities after self-poisoning. Immediate toxicity is mainly due to a general anesthetic and due to a neuromuscular blocking agent, while delayed hepatotoxicity seems related to the solvent DMF. The protective role of N-acetylcysteine (NAC) administration remains debatable. Material and methods. Two male veterinarians (50- and 44-year-old) attempted suicide by injecting T-61 in the precordial area for the first one, and by ingesting 50 mL for the second. Both received NAC (for 14 days in the first case and only for 20 h in the second). Urine was collected for the serial determination of DMF, N-methylformamide (NMF), and N-acetyl-S-(N-methylcarbamoyl)cysteine (AMCC). Results. Both patients developed only mild signs of liver injury. The metabolite of DMF, NMF, appeared rapidly in the urine, while a further delay was necessary for AMCC excretion. The kinetics of elimination of DMF and DMF metabolites were slightly slower than those reported in exposed workers. Conclusions. While both patients had a favorable outcome, there is no clear evidence that NAC could directly influence NMF and AMCC excretion. Further investigations of NMF and AMCC excretion, with and without NAC, would be indicated.

Expositions accidentelles d’enfants aux détergents liquides en capsules : expérience du centre antipoison de Paris (2011–2012)

OBJECTIVE To evaluate the toxicity of liquid detergent capsules for children. METHODS Analysis of 684 consecutive cases from the Paris Poison Center (2011-2012). RESULTS Most enquiries (97 %) concerned children 5 years of age or younger. The main circumstances of exposure were ingestion alone (72.4 %) or together with eye or skin contact (7.5 % and 7.3 %, respectively). The effects observed were generally due to the irritating properties of concentrated detergents: minor digestive disturbances (particularly vomiting in nearly 50 % of cases) after ingestion and conjunctivitis and/or keratitis after eye contact. The main complications were 24 cases of keratitis and one case of pulmonary toxicity after ingestion. A rash was observed in nine patients; it was delayed in two. CONCLUSIONS The effects observed with liquid detergent capsules were very similar to those resulting from exposure to other detergents. However, exposure to these agents are very frequent and often results in eye contact, which may be responsible for keratitis, and after ingestion detergent inhalation is a possible complication. All cases with eye symptoms or cough after liquid detergent capsule exposure deserve prompt medical examination and assistance. Greater awareness of both health professionals and consumers on the dangers and risks of these laundry detergent pods is required for better treatment of exposure accidents and for their prevention.

Tender Nesting Polypore (Hapalopilus rutilans) poisoning: report of two cases

Abstract Introduction. Only four cases of Hapalopilus rutilans poisoning have been previously published. We report two new cases. Case reports. A father and his 13-year-old daughter picked mushrooms identified as Fistulina hepatica specimens and ate an unknown quantity (Hour 0). At Hour 12 post-ingestion, both subjects complained of abdominal pain, then nausea, vomiting, anorexia, asthenia, diplopia, and blurred vision. The father also had visual hallucinations. On Day 2 post-ingestion, clinical examination showed multidirectional nystagmus. The father also had balance disorders and both subjects emitted purple urine. Laboratory tests showed elevated serum creatinine and blood urea levels, proteinuria and leukocyturia in both subjects, and mild elevation of hepatic enzymes in the father. Urine color returned to normal on Day 2 and Day 7 post-ingestion in the girl and her father, respectively. Complete clinical and biochemical recovery was obtained within one week in both cases. Discussion. Signs and symptoms are similar to those previously reported after H. rutilans ingestion. This mushroom can be easily confused with F. hepatica. Purple discoloration of the urine after ingestion of a polyporic mushroom is highly suggestive of H. rutilans poisoning. Polyporic acid is probably the active toxin.

Acute indoramin poisoning: a review of 55 cases reported to the Paris poison centre from 1986 t o 2010

Authors report a retrospective study of all cases of indoramin-only poisoning notified to the Paris poison Centre from 1986 to 2010. Fifty five cases of indoramin self-poisoning were included: 40 adults and 15 children. The mean supposed ingested dose was about 701mg±464mg. ECG showed a prolonged QTc interval (equal to or greater than 0.50s) in 30% of patients. The lowest observed dose for prolonged QTc was 625mg. This series includes two cases of seizures occurring around two hours after ingestion of 900 and 2 250mg of indoramin. A review of the literature showed cardiac disorders, with a delayed mechanism of action up until 18hours after ingestion. Therefore, rapid medical resuscitation and prolonged cardiac monitoring for at least 24hours after ingestion of 625mg are recommended.Authors report a retrospective study of all cases of indoramin-only poisoning notified to the Paris poison Centre from 1986 to 2010. Fifty five cases of indoramin self-poisoning were included: 40 adults and 15 children. The mean supposed ingested dose was about 701 mg±464 mg. ECG showed a prolonged QTc interval (equal to or greater than 0.50 s) in 30% of patients. The lowest observed dose for prolonged QTc was 625 mg. This series includes two cases of seizures occurring around two hours after ingestion of 900 and 2 250 mg of indoramin. A review of the literature showed cardiac disorders, with a delayed mechanism of action up until 18 hours after ingestion. Therefore, rapid medical resuscitation and prolonged cardiac monitoring for at least 24 hours after ingestion of 625 mg are recommended.

Avvelenamenti acuti più frequenti

Gli avvelenamenti restano una delle cause principali di ospedalizzazione nei soggetti giovani. Occorre notare che la media di eta dei suicidi in Francia si alza progressivamente e che, parallelamente, aumentano costantemente gli avvelenamenti, volontari o accidentali, delle persone anziane. La contrapposizione classica tra avvelenamento accidentale e suicidio e attualmente sostituita da delle nozioni piu complesse ma anche piu realistiche: suicidio, sovradosaggio senza volonta di morte, interazione farmacologica, effetti secondari di farmaci e sostanze ricreative, avvelenamento accidentale, avvelenamenti auto- o eteroinflitti. Noi ci troviamo solo all’inizio di una nuova classificazione delle circostanze degli avvelenamenti. I dati del servizio di soccorso medico di urgenza (SAMU) 93 mostrano, in modo sorprendente, e nonostante tutti i progressi della farmacologia e dell’industria farmaceutica volti a immettere sul mercato dei prodotti piu attivi e meno tossici, che il numero di avvelenamenti gravi non diminuisce. Per la prima volta, il centro antiveleni di Parigi rivela i 100 farmaci in causa negli avvelenamenti piu frequenti. Questi dati permettono di affermare che, mentre gli avvelenamenti sono frequenti, sono dovuti a una miriade di prodotti e che, in effetti, molti avvelenamenti appartengono al campo delle malattie rare. L’approccio medico al paziente intossicato deve rimanere clinico, con una priorita per il trattamento sintomatico. Le indicazioni e le modalita di decontaminazione gastrointestinale sono ora perfettamente e chiaramente definite. Gli antidoti hanno fatto ancora dei progressi, e alcuni di essi devono essere considerati dei farmaci di prima linea. Deve essere sottolineato il ruolo essenziale di informazione dei centri antiveleni a causa della recrudescenza dei principi attivi all’origine di avvelenamenti e delle interazioni complesse, mentre centri di rianimazione specializzati nella gestione degli avvelenamenti offrono un’opportunita supplementare di evoluzione favorevole grazie a nuovi antidoti e a tecniche di eccezione come l’assistenza circolatoria in occasione di avvelenamenti con farmaci a effetto stabilizzatore delle membrane, cause frequenti di avvelenamento.