Hydroxocobalamin treatment of acute cyanide poisoning from apricot kernels

Clinical experience with hydroxocobalamin in acute cyanide poisoning via ingestion remains limited. This case concerns a 35-year-old mentally ill woman who consumed more than 20 apricot kernels. Published literature suggests each kernel would have contained cyanide concentrations ranging from 0.122 to 4.09 mg/g (average 2.92 mg/g). On arrival, the woman appeared asymptomatic with a raised pulse rate and slight metabolic acidosis. Forty minutes after admission (approximately 70 min postingestion), the patient experienced headache, nausea and dyspnoea, and was hypotensive, hypoxic and tachypnoeic. Following treatment with amyl nitrite and sodium thiosulphate, her methaemoglobin level was 10%. This prompted the administration of oxygen, which evoked a slight improvement in her vital signs. Hydroxocobalamin was then administered. After 24 h, she was completely asymptomatic with normalised blood pressure and other haemodynamic parameters. This case reinforces the safety and effectiveness of hydroxocobalamin in acute cyanide poisoning by ingestion.

Primary aortoduodenal fistula: a challenge to the vascular surgeon

Primary aortoduodenal fistula is a serious and rare complication of abdominal aortic aneurysms. This life-threatening disease results most commonly from an abdominal aortic aneurysm, with the fistula forming between the aorta and the third or the fourth portions of the duodenum. Diagnosis is often difficult and urgent adequate surgical treatment as soon as possible is the only therapeutic option to save the lives of these patients. In this paper we report the case of a 76-year-old female admitted to our institution for massive haematemesis, melaena, severe hypotension and violent back pain. The urgent diagnostic work-up revealed an abdominal aortic aneurysm with a strong suspicion of duodenal fistulisation. The diagnosis was confirmed in the operating room, where the patient was immediately submitted to closure of the fistula and in situ aortic reconstruction using an aortic homograft. The postoperative course was uneventful and after 6 months the patient is doing well without any recurrence of infection.

Dementia, delusions and seizures: storage disease or genetic AD?

We describe a case of a young patient suffering from a rapidly progressive cognitive decline, associated with delusions, myoclonus and seizures and with no family history for dementia. Clinical features, along with skin biopsy findings were overlapping storage disease; the genetic analysis, however, demonstrated a de novo presenilin 1 mutation. The present report suggests the usefulness of genetic determinations in early-onset cases of dementia, even without an autosomal dominant trait of inheritance; for these cases and their relatives an extensive genetic counselling should be recommended.

Pleural effusion as a complication of intrathoracic goitre

The authors report their experience with a case of bilateral pleural effusions as a complication of intrathoracic goitre. They then go on to examine all the possible causes of this phenomenon. After discussing the anatomy of the superior mediastinum, they conclude that hydrothorax related to intrathoracic goitre could be the result of pressure of the mass on venous structures, especially on the superior vena cava, or on the intramediastinal lymphatic vessles, or, as in the case reported, on both.

Warthin's tumour of the parotid gland

The authors, after examining two recent cases, explain a number of basic concepts regarding the diagnosis and therapy of Warthin's tumour of the parotid gland. Despite their low frequency, such tumours are very important because of their aetiopathogenesis, which is still controversial, and the recent increase in their incidence in females. Today, the diagnostic protocol, undertaken after the necessary clinical examination, relies mainly on ultrasonography and CT, but only a postoperative histological examination is capable of yielding a sure diagnosis and establishing the main histomorphological characteristics of the tumour. The therapeutic approach can be limited to conservative treatment, sparing the parotid gland and its vascularization and innervation.