Wild mushrooms poisoning: a public health challenge

Issue

Mushrooms are considered as ingredient of gourmet cuisine across the globe and mushroom poisonings can occur because of misidentification of a poisonous species as edible. Of the vast number of mushroom species, approximately 100 are toxic(**).

Description of the Problem

Mushroom poisoning is a public health problem. People should be educated about this poison as often there are no guidelines about the treatment of mushroom toxicity. Despite treatment, the prognosis can be mortal. In the Department of Hygiene and Health Prevention (ATS Val Padana, Italy) expert mycologists offer their consultation free of charge to people who pick mushrooms and register, for each consultation, quantity and toxicity of collected mushrooms.

Results

In 2018-19, 279 consultations were offered: 124(44.44%) in 2018, 155 (55.56%) in 2019. 58.42% of mushrooms were considered not dangerous for human health, without any difference among the two considered years (p = 0.167). 233.7 kg mushrooms were considered edible (mean 2.71, SD 16.44), 92.95 kg were considered dangerous and destroyed (mean 1.39, SD 6.99). The most identified species were: Agrocybe aegerita (11.47%), Armillaria Mellea (29.75%), Boletus edulis (6.45%), Macrolepiota venenata** (1.43%, N = 4), Xerocomus badius (2.51%), Lyophillum loricatum (1.79%), Agaricus Xanthodermus** (3.23%, N = 9). Intoxications occurred among people who did not refer to our mycology unit.

Conclusions

Mushroom poisoning represents a major health risk and as it's often consequence of misidentification, a free of charge consultation offered by experts is fundamental to avoid intoxications or deaths.

Key messages

Mushroom poisoning presents a major health risk. A free of charge consultation offered by experts is fundamental to avoid intoxications or deaths.

Surgical treatment of aortic dissections: initial experience with the adventitial inversion technique

BACKGROUND

The adventitial inversion technique obliterates the false lumen and converts a dissected aorta into a conduit with tough adventitia on the inside and outside. Dacron grafts can be anastomosed to the aorta with fine sutures, which hold without tears.

METHODS

From August 1995 to March 1997, we treated 6 patients with acute dissecting aneurysms. Three aneurysms were type I (A) involving the entire aorta, two type II (A) involving the ascending aorta, and one type III (B) involving the thoracoabdominal aorta. Circulatory arrest was used in 3 patients, 1 with type I aneurysm (A), 1 type II (A), and 1 type III (B).

RESULTS

All Dacron-aorta anastomoses held sutures well and did not bleed intraoperatively or postoperatively. One patient (type II [A]) died of intraoperative low cardiac output. In patients with type I (A) aneurysms, the false lumen was obliterated, but 1 patient required resection of a 6-cm abdominal aortic aneurysm.

CONCLUSIONS

The adventitial inversion technique is a safe technique for the treatment of acute dissecting aneurysms, which facilitates operation and solves the problem of intraoperative or postoperative bleeding due to tissue friability.

Pheocromocytoma and gastrointestinal bleeding

A 46-year-old patient who presented with an abdominal mass and gastrointestinal bleeding associated with an extra-adrenal pheochromocytoma is discussed. He had no history of hypertension. An ill-defined mass was felt at the upper abdomen. CT and arteriography confirmed the presence of a large mass with calcifications in the right paravertebral region. Upper endoscopy revealed multiple varices at the third portion of the duodenum. Abdominal exploration revealed a huge tumor at the root of the small bowel mesentery with multiple arterial and venous vessels entering the third portions of the duodenum. The tumor was unresectable. Biopsy demonstrated a pheochromocytoma. The patient developed pulmonary edema in the immediate postoperative course. He recovered and was discharged home on Dibenzyline. He has been readmitted on various occasions with gastrointestinal bleeding and congestive heart failure. Presently he is working and feels relatively well 5 years after the operation. A review of the literature for gastrointestinal complications of pheochromocytomas was done. There is a scarcity of reports of gastrointestinal bleeding associated with pheochromocytomas.

Right coronary artery with anomalous origin and slit ostium

Right coronary arteries that arise from the left sinus or ectopically from the right sinus with a slit ostium can cause myocardial ischemia, myocardial infarction, or sudden death. The surgical repair of these anomalies has evolved toward a simpler operation that widens the orifice of origin and reduces the compression of the intramural segment. We have repaired these anomalies without mortality in 8 patients. We summarize our experience and the evolution of this procedure.

Cardiac surgery on Jehova's Witnesses at Instituto Cardiovascular-Hospital Pavia

Jehovah's Witnesses (J.W.) can undergo successful cardiac operations. We have operated five J.W. patients. Of these patients, two had coronary artery bypass surgery and three had correction of congenital anomalies. These included an atrial septal defect with infundibular pulmonic stenosis, a tetralogy of Fallot and a patient with a ventricular septal defect. Our treatment protocol includes a meticulous surgery, the use of early heparinization to collect all shed blood into the pump oxygenator, observation in the operating room for early exploration if the patient bleeds and administration of iron preparations. Recombinant human erythropoietin, although available and in our treatment protocol, has not been used yet. All patients survived the operation and left the hospital with an excellent hemoglobin and hematocrit. The length of stay varied from 7 to 15 days.