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The authors report the observation of lead poisoning in a young Moroccan woman, which was caused by prolonged use of a khol made of lead sulphide. Khol is a black eye make-up used since Ancient Egypt. Clinically, this poisoning presented with abdominal crampoid pain, encephalopathy (manifested as anxiety and irritability), a Burtonian gingival border and microcytic sideropenic anaemia. Emergency chelate treatment permitted to improve clinical state and to decrease blood levels (initial blood concentration: 490 micrograms/dl; concentration six weeks after treatment: 49 micrograms/dl). The interest of such a case is recognizing, in French speaking regions, of a public health problem, largely ignored, although real, considering the high lead concentrations found in a majority of kohls available in Brussels and this very old cultural practice among Muslim populations.
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PMID:[Use of kohl and severe lead poisoning in Brussels]. 1258 49

The authors, on performing a critical analysis of reported data on clinical manifestations of lead intoxication, suggest that the initial manifestations thereof presenting as changes in no other indices but laboratory ones, be regarded as a preclinical stage. Aside from generally recognized concepts of "mild" and "prominent" stages in lead intoxication the authors consider it logical and expediant to introduce a moderately severe stage manifested by vegetosensory polyneuropathy, astheno-vegetative syndrome, dyskinesia of the biliary and intestinal tracts, spastic colitis. It is in this very stage of lead intoxication that the patient, to the author's thinking, is to be assigned to some other job where he/she will not be exposed to lead or other adverse occupational factors. This will, we believe, permit preventing development of a clinically significant stage of lead intoxication manifested by encephalopathy, motor form of polyneuropathy, lead colic, anemia and hepatitis.
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PMID:[Clinical stages of lead intoxication]. 1258 28

Coagulation disorders are common in cancer patients. In patients with solid tumors, a low-grade activated coagulation can result in systemic and cerebral arterial or venous thrombosis. Cancer treatments may also contribute to this coagulopathy, which usually, but not exclusively, occurs in the setting of advanced malignant disease. There may be TIAs or cerebral infarctions. Because of the widespread distribution of cerebral thromboses, there may be a superimposed encephalopathy; sometimes this is the only sign. Concurrent systemic thrombosis is present in many patients and is a useful clue to the diagnosis. In cerebral venous occlusion, the initial symptom is usually a headache. Except for cerebral intravascular coagulation that is unassociated with NBTE, neuriomaging studies usually demonstrate one or more parenchymal infarctions. MRI or MRV may demonstrate venous thrombosis. The laboratory evidence of coagulopathy is difficult to distinguish from the asymptomatic coagulopathy that often accompanies advanced cancer, and the test results must be interpreted cautiously. NBTE can be diagnosed by transesophageal echocardiography. There is no established treatment for the thrombotic coagulopathy associated with cancer, but anticoagulation should be considered. In leukemia and lymphoma, the coagulopathy is typically acute DIC that can lead to systemic and brain hemorrhages. It is especially common in acute myelogenous leukemias. The clinical signs of cerebral hemorrhage are fulminant and may be fatal. The bleeding usually occurs in the brain or subdural compartment, and rarely in the subarachnoid space. The diagnosis can be suspected by the clinical setting and by systemic thrombosis or hemorrhage. It can be established by examination of the peripheral smear, the platelet count, and tests of coagulation function. Therapy of acute DIC is controversial and should be individualized for the clinical setting. Cerebrovascular disorders can complicate metastatic or primary tumor in the brain, skull, dura, or leptomeninges. The clinical signs of infarction are indistinguishable from other causes of stroke, except that tumor-related venous occlusion will usually first produce signs of increased intracranial pressure. The diagnosis of tumor-related infarction can usually be established by neuroimaging studies that show infarction and may show extracerebral sites of tumor. CSF examination is useful in diagnosing leptomeningeal metastasis. A search for lung or cardiac tumor should be performed when embolic tumor infarction is suspected. Primary or metastatic tumors in the brain or dura may hemorrhage, producing the initial clinical signs of the brain tumor or a change in chronic signs induced by the tumor. There are helpful clues to a neoplastic hemorrhage on brain CT or MRI scans. The brain hemorrhage may require evacuation and the underlying tumor will usually require additional antineoplastic treatment. Hyperleukocytosis (extreme elevation of the cell count) in acute myelogenous leukemia is a less common cause of brain hemorrhage in recent years because of improved methods to lower the cell count. Cerebral arterial or venous thrombosis is sometimes the result of cancer therapy. The attribution of thrombosis to chemotherapy in many published cases is only speculative, because carefully conducted prospective studies that include investigation for other thrombotic causes are not available. The best-known associations with thrombosis are L-asparaginase, which is typically used in the induction therapy of acute lymphocytic leukemia, and combination hormonal therapy and chemotherapy for breast cancer. Radiation to the head and neck, typically administered for head and neck epithelial cancers or lymphoma, may result in delayed carotid atherosclerosis. The distribution of stenosis or occlusion is within the radiation portal and is typically more extensive than is atherosclerosis that develops in the absence of radiation. Small clinical series suggest that surgical treatment is equally effective as in nonirradiated carotid atherosclerosis. In children, the cerebral vessels can be affected by brain radiation resulting in stenosis or occlusion. Brain hemorrhages can result from chemotherapy effects on the hemostatic system or a microangiopathic anemia. Hemorrhages from radiation-induced vascular abnormalities are rare. Opportunistic infections, especially fungal infections, can complicate cancer or its treatment. Septic cerebral emboli may result in focal cerebral signs, seizures, or encephalopathy. Sometimes there is an associated hemorrhagic vasculitis or cerebritis. Rarely, mycotic aneurysms may bleed. A high index of suspicion is needed to diagnose fungal infection because of the difficulty in culturing the organism from the blood or CSF. A clinician can usually establish the cause of stroke in the cancer patient by performing a careful review of the clinical setting--including the type and extent of cancer and the type of antineoplastic therapy--in which the stroke occurred. Systemic thrombosis, embolism, or hemorrhage can be a clue to the cause, and appropriate neuroimaging and coagulation studies to aid in the diagnosis are available. Therapy may ameliorate symptoms or prevent further episodes. The identification of one of these unusual stroke syndromes that leads to the diagnosis of an occult and treatable cancer can be particularly rewarding.
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PMID:Cerebrovascular complications in cancer patients. 1269 Jun 49

A 34-year-old female with end-stage renal disease was admitted for severe metabolic acidosis, uremic encephalopathy, pericarditis and severe anemia following a bout of acute gastroenteritis. She improved on aggressive medical management including intensive hemodialysis and was initiated onto maintenance heparin-free hemodialysis (twelve hours per week) and discharged. After a week, she presented with fever with chills and rigors for three days, was toxic, severely orthopenic and had a pulsus paradoxus of 36 mmHg. Echocardiography suggested cardiac tamponade. Aspiration revealed frank pus with polymorphonuclear predominance and Staphylococcus aureus on culture. CT of the thorax revealed pericardial effusion. In the absence of any obvious septic foci, concomitant pleuro-pulmonary sepsis, mediastinal or intra-abdominal pathology; a diagnosis of "acute primary purulent pericarditis" was made. Patient was put on parenteral antibiotics-ceftriaxone and metrogyl. Vancomycin was added after sensitivity results. Pericardial drainage was required initially. After toxemia improved, paradox decreased and fever subsided, the pericardial catheter was removed and antibiotics continued for a period of four weeks. Maintenance hemodialysis was continued during hospital stay and after discharge.
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PMID:Staphylococcal pericarditis in a chronic renal failure patient. 1280 14

Lead is an element that has no known physiologic function in humans but adversely affects a variety of fundamental biochemical processes. A large body of evidence shows adverse health effects of lead in children at levels common in populations around the world. Acute lead poisoning with encephalopathy, though infrequent, is life-threatening, requiring timely and aggressive treatment. It should be considered in the differential diagnosis of any unexplained illness that includes anemia, seizures, lethargy, abdominal pain, or recurrent vomiting. Many more children are harmed by chronic, subclinical effects of low-level lead exposure that include impaired cognitive development, adverse effects on behavior, subtle impairment of hearing acuity, and reduced height. Available evidence indicates that the only effective interventions to prevent low level lead toxicity are those that control lead exposure. The English version of this paper is available at: http://www.insp.mx/salud/index.html.
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PMID:[Effects of lead exposure on children's health]. 1474 7

Children with end-stage liver disease have been found to have cognitive deficits. The aim of this study was to examine whether cholestatic jaundice causes spatial deficits in rats and if these cognitive deficits are reversed by biliary drainage. Rats were randomly divided into three groups. In the first group, the bile duct was ligated for 3 weeks (BDL group); in the second group, the proximal bile duct was ligated with a Broviac CV catheter for 2 weeks followed by a tube bilioduodenostomy (TBD group); in the third group, a sham operation was performed (SHAM group). All the surviving rats were assessed for spatial learning and memory (a major cognitive function in rats) by the Morris water maze task about 3 weeks after the first operation. Blood was aspirated by cardiocentesis and assayed for total bilirubin, albumin, ammonia, and hemoglobin levels on the day following the water maze task. During the four consecutive acquisition trial days of the Morris water maze, jaundiced rats (BDL group) had a significant longer latency to escape than the SHAM group ( p < 0.05). Rats that underwent biliary decompression for 1 week (TBD group) showed improved status of the spatial deficit, as they required less time to reach the escape platform, approaching the performance of the SHAM group. The BDL group had a significantly higher serum ammonia level, higher bilirubin level, and lower hemoglobin level than the other two groups. After biliary decompression for 1 week, the serum albumin concentration in the TBD group still did not return to the level of the SHAM group. The results of this study suggest that long-term cholestasis results in spatial memory deficits in rats that correlate with anemia and hyperbilirubinemia encephalopathy. Early biliary decompression of obstructive jaundice improves spatial memory deficits, possibly related to the recovery of the serum ammonia and hemoglobin levels.
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PMID:Obstructive jaundice in rats: cause of spatial memory deficits with recovery after biliary decompression. 1496 Nov 95

The National Neonatal Perinatal Database (NNPD) network is a collaborative group of leading neonatal units in India involved in the prospective collection of morbidity and mortality data on uniform protocols. The present article reports the morbidity and mortality profile of outborn neonates in the year 2000. Ten centers provided data on outborn neonates. The data were analysed at the nodal center using Epi-Info statistical software version 6 and Excel 97. A total of 3831 neonates were admitted at the participating institutions. A majority of them (87.2 per cent) were delivered in nursing homes and small hospitals. Most of the admissions (68.7 per cent) were male. Nearly half of them (48.7 per cent) were low birthweight and one-third (32.1 per cent) were preterm. Overall mortality was 16.4 per cent, while 7.5 per cent left hospitals against medical advice. Nearly half of all neonatal deaths occurred within the first 48 h following admission. Common primary causes of deaths (n = 630) included: infections (36.0 per cent), prematurity related conditions (26.5 per cent), perinatal hypoxia (10.0 per cent), and malformations (7.8 per cent). Systemic infections (28.4 per cent), hyperbilirubinemia (27.9 per cent), seizures (11.7 per cent), hypoglycemia (11.5 per cent), hypoxic ischemic encephalopathy (8.3 per cent), anemia (8.9 per cent), and hypocalcemia (8.6 per cent) were common morbidities observed. Of systemic infections, 39.2 per cent were culture positive and 51.4 per cent were early onset (< 72 h). Sick babies were managed with antibiotics (75 per cent), oxygen administration (45.3 per cent), phototherapy (34.9 per cent), and assisted ventilation (16.3 per cent). In conclusion, the present study describes the morbidity and mortality profile of a large multicentric cohort of outborn neonates from a developing country.
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PMID:Morbidity and mortality among outborn neonates at 10 tertiary care institutions in India during the year 2000. 1523 94

Cognitive dysfunction has been reported in subsets of cancer patients and has been related to their underlying disease (small-cell lung cancer [SCLC]) or to a specific therapy (prophylactic cranial irradiation in SCLC, chemotherapy in breast cancer). Patients with uremic encephalopathy who have had their hemoglobin levels normalized by erythropoietic therapy have shown improved cognitive function in some studies. The mechanism responsible for the improvement is unknown and might reflect either a direct neuroprotective effect of erythropoietins on the central nervous system or the benefit of increased tissue oxygenation secondary to the correction of peripheral anemia. Whether erythropoietic agents can affect the cognitive dysfunction reported among some cancer patients is currently being investigated. The current state of knowledge about the use of erythropoietic agents for neuroprotection or the treatment of neurologic syndromes is described.
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PMID:Erythropoietic agents in the management of cancer patients. Part 2: studies on their role in neuroprotection and neurotherapy. 1533 Mar 71

Acute complications after bariatric surgery include rhabdomyolysis and immobilization hypercalcemia. The most common long-term metabolic complications following bariatric surgery are anemia and metabolic bone disease. Neuropathy, acute Wemicke's encephalopathy and vitamin A deficiency also occur. Prevention, diagnosis,and treatment of these disorders are necessary parts of lifelong care after bariatric surgery.
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PMID:Metabolic complications of bariatric surgery: diagnosis and management issues. 1582 36

During the 20th century, occupational and environmental exposure to lead was among the main relevant issues studied by occupational physicians, hygienists, and public health administrators. During the different decades there was a progressive reduction in exposure levels and in the mean time a progressive reduction in the severity of clinical symptoms due to very high exposure to this metal. During thefirst forty years of the 20th century, a clear decrease in the frequency of encephalopathy and paralysis of the radial nerve was observed while abdominal colics and anaemia where frequently observed until the sixties. In the first part of the seventies, there was a clear change in the preventive approach to lead poisoning both in the field of research and in the clinical-preventive and legal field. These successful results where obtained despite the disagreement of outstanding physicians and international renowed researchers and industrial associations. Every successful battle allowed a great improvement in the field of occupational and environmental prevention, but the above-mentioned disagreements caused a great delay in the solution of the problem and did not improve workers', children's and teenagers' health. In Italy, there was a very deep interest in the prevention of lead poisoning which led to very good results in a relatively short period even though the current laws did not help and also nowadays do not help the occupational professionals studying and dealing with occupational health. Lead undoubtly represents one of the most largely studied environmental industrial toxics and shows a model, also suitable for other matters involving exposure to different industrial toxics. Nevertheless, there are still problems in the understanding of some pathogenetic aspects of lead and in the significance of some of its early effects which deserve further studies. These matters, strictly linked to low-dose exposure, still present numerous questions. For example, there should be a deep interest in the standardization of its internal dose indicators, in the study the role of the metal in the pathogenesis of cardiological and nephrological diseases, in the characterization of its genetic polymorphisms and in the assessment of its carcinogenicity. A lot of these issues, already examined in old studies concerning casistics of workers affected by lead poisoning, have been analyzed in the multidisciplinary study "Progetto MIUR Piombo" (Project on lead by the Italian Ministry of University and Research) conducted by six different Institutes of Occupational Health (Cagliari, Parma, Perugia, Bari, Ancona and Brescia) which will report their results during this Congress.
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PMID:[From lead colic to moderate risk]. 1591 60


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