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Höllriegl V, Roth P, Werner E, Schramel P, Wendler I, Felgenhauer N, Zilker T. Influence of calcium on the uptake of ingested strontium. KERNTECHNIK 2022. [DOI: 10.1515/kern-2003-0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Radioactive isotopes of strontium, mainly 90Sr, released into the environment due to nuclear accidents may contribute significantly to the internal radiation exposure of members of the public after ingestion of strontium with contaminated foodstuffs. The committed radiation dose is significantly dependent on the fraction of the ingested activity that crossed the gut wall (f1 value). The directive 96/29/EURATOM has adopted f1 values of 0.3 for adults. This study was aimed to investigate how far the calcium content of foodstuffs influences the uptake of ingested strontium. For aqueous solutions without calcium containing 1 mg strontium, f1 values of 0.62 ± 0.13 (mean ± SD) were obtained. However, the uptake of 1 mg Sr from milk, and respectively from solutions with calcium was lower than from aqueous solution (f1: = 0.32 ± 0.06, respectively f1: = 0.31 ± 0.06). The data obtained show a significant reduction of the uptake of ingested strontium from milk in comparison to aqueous solution. The calcium content of milk could explain this reduction.
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Affiliation(s)
- V. Höllriegl
- Institute of Radiation Protection, GSF National Research Center for Environment and Health , Ingolstädter Landstrasse 1 , Neuherberg , Germany
| | - P. Roth
- Institute of Radiation Protection, GSF National Research Center for Environment and Health , Ingolstädter Landstrasse 1 , Neuherberg , Germany
| | - E. Werner
- Institute of Radiation Protection, GSF National Research Center for Environment and Health , Ingolstädter Landstrasse 1 , Neuherberg , Germany
| | - P. Schramel
- Institute of Ecological Chemistry, GSF National Research Center for Environment and Health , Ingolstädter Landstrasse 1 , Neuherberg , Germany
| | - I. Wendler
- Institute of Ecological Chemistry, GSF National Research Center for Environment and Health , Ingolstädter Landstrasse 1 , Neuherberg , Germany
| | - N. Felgenhauer
- Department of Toxicology of the II. Medical Clinic of Technical University Munich , München , Germany
| | - T. Zilker
- Department of Toxicology of the II. Medical Clinic of Technical University Munich , München , Germany
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Geldner G, Koch EM, Gottwald-Hostalek U, Baud F, Burillo G, Fauville JP, Levi F, Locatelli C, Zilker T. Report on a study of fires with smoke gas development : determination of blood cyanide levels, clinical signs and laboratory values in victims. Anaesthesist 2013; 62:609-16. [PMID: 23917894 DOI: 10.1007/s00101-013-2209-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 06/13/2013] [Accepted: 06/25/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND This is a report on an international non-interventional study of patients exposed to fires with smoke development in closed rooms. The objective of the study was to document clinical symptoms, relevant laboratory values and blood cyanide concentrations from fire victims in order to confirm or rule out presumptive correlations between the individual parameters. MATERIALS AND METHODS The study was conducted in five European countries with patients being included if they presented with the characteristic clinical signs, such as soot deposits and altered neurological status. Venous blood samples were taken from victims prior to administration of an antidote in all cases and determination of cyanide concentration was performed in a central laboratory using high performance liquid chromatography. RESULTS Data from 102 patients (62 % male, average age 49 years) were included in the evaluation with no blood samples being available for analysis from 2 patients. In 25 patients the blood cyanide concentration was below the limit of detection of 1.2 μmol/l. Cyanide levels between 1.2 and 10 μmol/l were measured in 54 patients, 7 patients had values between 10 and 20 μmol/l, 4 patients between 20 and 40 μmol/l while levels above 40 μmol/l were determined in 10 patients. The results of the study could not demonstrate that the cyanide level was influenced either by the interval between smoke exposure and blood sampling or the duration presence at the fire scene. The following clinical signs or laboratory values were recorded as relevant for increased and possibly toxic cyanide levels: respiratory arrest, dyspnea, resuscitation requirement, tracheal intubation, respiratory support measures, low Glasgow coma scale (GCS) score and respiratory frequency. A correlation between cyanide concentration and the total amount of soot deposits on the face and neck, in the oral cavity and in expectoration was confirmed. A correlation between cyanide and carboxyhemoglobin (COHb) levels in the blood of fire victims was also confirmed. CONCLUSIONS As long as it is not possible to immediately determine the blood cyanide concentration in patients exposed to fire with smoke development, a decreased GCS score, soot deposits particularly in expectoration, dyspnea and convulsions are to be regarded as risk markers for intoxication. In their presence immediate administration of hydroxocobalamin as an antidote is recommended.
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Affiliation(s)
- G Geldner
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Ludwigsburg, 71640, Ludwigsburg, Germany.
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Eyer F, Schuster T, Felgenhauer N, Pfab R, Strubel T, Saugel B, Zilker T. Risk Assessment of Moderate to Severe Alcohol Withdrawal--Predictors for Seizures and Delirium Tremens in the Course of Withdrawal. Alcohol Alcohol 2011; 46:427-33. [DOI: 10.1093/alcalc/agr053] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Eyer F, Schreckenberg M, Hecht D, Adorjan K, Schuster T, Felgenhauer N, Pfab R, Strubel T, Zilker T. Carbamazepine and Valproate as Adjuncts in the Treatment of Alcohol Withdrawal Syndrome: A Retrospective Cohort Study. Alcohol Alcohol 2011; 46:177-84. [DOI: 10.1093/alcalc/agr005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Thiermann H, Eyer F, Felgenhauer N, Pfab R, Zilker T, Eyer P, Worek F. Pharmacokinetics of obidoxime in patients poisoned with organophosphorus compounds. Toxicol Lett 2010; 197:236-42. [DOI: 10.1016/j.toxlet.2010.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 06/02/2010] [Accepted: 06/03/2010] [Indexed: 11/30/2022]
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Abstract
HISTORY AND ADMISSION FINDINGS Seventeen East-European workers with a suspected lead-intoxication presented themselves to the Department of Toxicology. All of them had worked on the renovation of pylons of a high-tension line. The old paint, known to contain lead was removed with needle descalers. The patients had blood lead concentrations between 325 and 1124 microg/l, but no specific symptoms. The workers neglected the protective measures at their working-place. INVESTIGATIONS 12 of 17 workers had lead-concentrations above 400 microg/l (Reference < 90 microg/l). 10 of 17 patients showed an increased level of free protoporphyrins and all workers showed a decreased activity of delta-aminolaevulinacid-dehydratase (ALAD). TREATMENT AND COURSE Patients with lead-concentration above 700 microg/l were treated with the chelating agent meso-2,3-dimercaptosuccinic acid (DMSA) 3 x 200 mg/d for nine days. The patients with lead concentrations between 400 and 700 microg/l were treated which DMSA 3 x 100 mg/d. After the DMSA-treatment the lead-concentrations had dropped (p < 0.001). During the DMSA-therapy one patient had to be treated in the hospital because of a generalised allergic exanthema. CONCLUSION We report seventeen patients with high lead concentration in their blood due to occupational exposure. The high blood lead levels showed that the workers had not been protected adequately. This examplifies that occupational lead exposure still occurs, also in Germany. By patients with unspecific symptoms connected with lead exposure a biomonitoring for lead is necessary.
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Affiliation(s)
- R F Willi
- ehem. Toxikologische Abteilung, Klinikum rechts der Isar.
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Kehe K, Thiermann H, Balszuweit F, Eyer F, Steinritz D, Zilker T. Acute effects of sulfur mustard injury—Munich experiences. Toxicology 2009; 263:3-8. [DOI: 10.1016/j.tox.2009.04.060] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 04/20/2009] [Accepted: 04/21/2009] [Indexed: 10/20/2022]
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Willi R, Pfab F, Huss-Marp J, Buters JTM, Zilker T, Behrendt H, Ring J, Darsow U. Contact anaphylaxis and protein contact dermatitis in a cook handling chicory leaves. Contact Dermatitis 2009; 60:226-7. [PMID: 19338594 DOI: 10.1111/j.1600-0536.2008.01461.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R Willi
- Department of Dermatology and Allergy Biederstein, Technische Universität München, Biedersteiner Strasse, Munich, Germany
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Pfab R, Haberl B, Kleber J, Zilker T. Cerebellar effects after consumption of edible morels (Morchella conica, Morchella esculenta). Clin Toxicol (Phila) 2009; 46:259-60. [DOI: 10.1080/15563650701206715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Halbach S, Vogt S, Köhler W, Felgenhauer N, Welzl G, Kremers L, Zilker T, Melchart D. Blood and urine mercury levels in adult amalgam patients of a randomized controlled trial: interaction of Hg species in erythrocytes. Environ Res 2008; 107:69-78. [PMID: 17767927 DOI: 10.1016/j.envres.2007.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 05/16/2007] [Accepted: 07/20/2007] [Indexed: 05/17/2023]
Abstract
UNLABELLED Parts of the population are permanently exposed to low levels of Hg degrees and Hg(II) from dental amalgam. It was the aim (1) to investigate the internal exposure to amalgam-related mercury from the kinetics of inorganic Hg in plasma and erythrocytes after amalgam removal, and (2) to estimate the amalgam-related absorbed dose. Dietary coexposure was monitored by determination of blood organic-Hg. Postremoval steady-state Hg concentrations were measured for 18 months. Eighty-two patients had been randomized into three groups: (A) removal of the fillings; (B) removal and non-specific detoxification, and (C) a health promotion program without removal. After amalgam removal, inorganic Hg dropped rapidly in plasma and red cells, stabilizing at 27% of preremoval levels after 60 days. Concentrations of organic Hg in plasma remained unchanged, indicating no change in dietary uptake of organic Hg. The concentration of organic Hg in red cells of group A was in the early postremoval phase lower and in the late postremoval phase higher than the preremoval control (p<0.01 for low-high difference). A protracted increase in organic Hg was also found in red cells of group B after 60 days. Thus, the effect of removal on organic Hg levels in the combined group A+B was compared with the values of group C in a linear mixed effects (LME) model which showed a significant increase with time in group A+B (p=0.028). In all groups, time profiles of urinary concentration and excretion of total-Hg were very similar to those of inorganic-Hg levels in plasma. From extrapolations of blood and urine data it was estimated that the amalgam-related inhalation and ingestion of Hg species were within the limits proposed by WHO, ATSDR and EPA. The integrated daily Hg dose absorbed from amalgam was estimated up to 3 microg for an average number of fillings and at 7.4 for a high amalgam load. CONCLUSIONS This is the first study on adult amalgam patients which continuously monitored the postremoval decline of inorganic Hg and the coexposure from dietary organic Hg in a randomized-controlled-trial design. The integrated daily dose of 7.4 microg absorbed from a high amalgam load is well below the tolerable dose of 30 microg (WHO, 1990). The unexpected postremoval increase in erythrocyte organic Hg, which is associated with the depletion of cellular inorganic Hg, might result from binding of organic Hg to cellular sites previously occupied by inorganic Hg.
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Affiliation(s)
- S Halbach
- Institute of Toxicology, GSF Research Center for Environment and Health, Munich, Germany.
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Melchart D, Vogt S, Köhler W, Streng A, Weidenhammer W, Kremers L, Hickel R, Felgenhauer N, Zilker T, Wühr E, Halbach S. Treatment of Health Complaints Attributed to Amalgam. J Dent Res 2008; 87:349-53. [DOI: 10.1177/154405910808700410] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of the present study was to compare the reduction of subjective complaints by 3 treatment strategies in 90 “amalgam patients” whose complaints could not be explained by a medical or psychological disorder. The individuals were randomly assigned either to removal of dental amalgam only (removal group), or removal in combination with a “biological detoxification” therapy with high doses of vitamins and trace elements (removal-plus group), or participation in a health promotion program without removal of dental amalgam (no-removal group). Between baseline and month 12, the sum score of main complaints decreased by 3.5 (SD = 2.2) points on average in the removal group as well as in the removal-plus group, and by 2.5 (SD = 2.4) points in the no-removal group (p = 0.152). Both removal groups showed a significant decrease in steady-state levels of inorganic mercury compared with the no-removal group. Thus, all 3 interventions were associated with clinically relevant improvements.
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Affiliation(s)
- D. Melchart
- Centre for Complementary Medicine Research, Internal Medicine II, Technische Universität München, Munich, Germany
- Division of Complementary Medicine, Department of Internal Medicine, University Hospital Zürich, Switzerland
- Department of Restorative Dentistry, Periodontology and Pediatric Dentistry, University of Munich, Germany
- Department of Clinical Toxicology, Internal Medicine II, Technische Universität München, Munich, Germany
- International Association for Holistic Dental Medicine, Mannheim, Germany; and
| | - S. Vogt
- Centre for Complementary Medicine Research, Internal Medicine II, Technische Universität München, Munich, Germany
- Division of Complementary Medicine, Department of Internal Medicine, University Hospital Zürich, Switzerland
- Department of Restorative Dentistry, Periodontology and Pediatric Dentistry, University of Munich, Germany
- Department of Clinical Toxicology, Internal Medicine II, Technische Universität München, Munich, Germany
- International Association for Holistic Dental Medicine, Mannheim, Germany; and
| | - W. Köhler
- Centre for Complementary Medicine Research, Internal Medicine II, Technische Universität München, Munich, Germany
- Division of Complementary Medicine, Department of Internal Medicine, University Hospital Zürich, Switzerland
- Department of Restorative Dentistry, Periodontology and Pediatric Dentistry, University of Munich, Germany
- Department of Clinical Toxicology, Internal Medicine II, Technische Universität München, Munich, Germany
- International Association for Holistic Dental Medicine, Mannheim, Germany; and
| | - A. Streng
- Centre for Complementary Medicine Research, Internal Medicine II, Technische Universität München, Munich, Germany
- Division of Complementary Medicine, Department of Internal Medicine, University Hospital Zürich, Switzerland
- Department of Restorative Dentistry, Periodontology and Pediatric Dentistry, University of Munich, Germany
- Department of Clinical Toxicology, Internal Medicine II, Technische Universität München, Munich, Germany
- International Association for Holistic Dental Medicine, Mannheim, Germany; and
| | - W. Weidenhammer
- Centre for Complementary Medicine Research, Internal Medicine II, Technische Universität München, Munich, Germany
- Division of Complementary Medicine, Department of Internal Medicine, University Hospital Zürich, Switzerland
- Department of Restorative Dentistry, Periodontology and Pediatric Dentistry, University of Munich, Germany
- Department of Clinical Toxicology, Internal Medicine II, Technische Universität München, Munich, Germany
- International Association for Holistic Dental Medicine, Mannheim, Germany; and
| | - L. Kremers
- Centre for Complementary Medicine Research, Internal Medicine II, Technische Universität München, Munich, Germany
- Division of Complementary Medicine, Department of Internal Medicine, University Hospital Zürich, Switzerland
- Department of Restorative Dentistry, Periodontology and Pediatric Dentistry, University of Munich, Germany
- Department of Clinical Toxicology, Internal Medicine II, Technische Universität München, Munich, Germany
- International Association for Holistic Dental Medicine, Mannheim, Germany; and
| | - R. Hickel
- Centre for Complementary Medicine Research, Internal Medicine II, Technische Universität München, Munich, Germany
- Division of Complementary Medicine, Department of Internal Medicine, University Hospital Zürich, Switzerland
- Department of Restorative Dentistry, Periodontology and Pediatric Dentistry, University of Munich, Germany
- Department of Clinical Toxicology, Internal Medicine II, Technische Universität München, Munich, Germany
- International Association for Holistic Dental Medicine, Mannheim, Germany; and
| | - N. Felgenhauer
- Centre for Complementary Medicine Research, Internal Medicine II, Technische Universität München, Munich, Germany
- Division of Complementary Medicine, Department of Internal Medicine, University Hospital Zürich, Switzerland
- Department of Restorative Dentistry, Periodontology and Pediatric Dentistry, University of Munich, Germany
- Department of Clinical Toxicology, Internal Medicine II, Technische Universität München, Munich, Germany
- International Association for Holistic Dental Medicine, Mannheim, Germany; and
| | - T. Zilker
- Centre for Complementary Medicine Research, Internal Medicine II, Technische Universität München, Munich, Germany
- Division of Complementary Medicine, Department of Internal Medicine, University Hospital Zürich, Switzerland
- Department of Restorative Dentistry, Periodontology and Pediatric Dentistry, University of Munich, Germany
- Department of Clinical Toxicology, Internal Medicine II, Technische Universität München, Munich, Germany
- International Association for Holistic Dental Medicine, Mannheim, Germany; and
| | - E. Wühr
- Centre for Complementary Medicine Research, Internal Medicine II, Technische Universität München, Munich, Germany
- Division of Complementary Medicine, Department of Internal Medicine, University Hospital Zürich, Switzerland
- Department of Restorative Dentistry, Periodontology and Pediatric Dentistry, University of Munich, Germany
- Department of Clinical Toxicology, Internal Medicine II, Technische Universität München, Munich, Germany
- International Association for Holistic Dental Medicine, Mannheim, Germany; and
| | - S. Halbach
- Centre for Complementary Medicine Research, Internal Medicine II, Technische Universität München, Munich, Germany
- Division of Complementary Medicine, Department of Internal Medicine, University Hospital Zürich, Switzerland
- Department of Restorative Dentistry, Periodontology and Pediatric Dentistry, University of Munich, Germany
- Department of Clinical Toxicology, Internal Medicine II, Technische Universität München, Munich, Germany
- International Association for Holistic Dental Medicine, Mannheim, Germany; and
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Hausteiner C, Huber D, Bornschein S, Bubel E, Groben S, Darsow U, Eberlein B, Zilker T, Ring J, Henningsen P. Prädiktoren für organisch unerklärte Beschwerden und somatoforme Störungen in der Allergologie. Psychother Psychosom Med Psychol 2008. [DOI: 10.1055/s-2008-1061563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
The influence of nutritional factors on brain metabolism and the course of mental illness are increasingly being addressed in international research. It is a matter of discussion whether dietary habits, e.g., the amount of fish or vegetables, have an effect on the incidence of certain illnesses. Furthermore an optimized or supplemented diet could offer therapeutic possibilities; one example is the role of polyunsaturated fatty acids as an add-on therapy in affective disorders. The limitations of psychopharmacotherapy (drug interactions, side effects, noncompliance) underline the theoretical and practical relevance of nutrition in mental illness, the more so as mentally ill patients (especially when demented, anorectic, depressed, or schizophrenic) are at higher risk of malnutrition anyway. Even if the therapeutic evidence is still limited and the effects may be relatively weak, nutritional assessment and an optimized diet can be recommended for every patient.
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Affiliation(s)
- C Hausteiner
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen Universität München, 81664 München.
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Hausteiner C, Bornschein S, Zilker T, Henningsen P, Förstl H. Dysfunctional cognitions in idiopathic environmental intolerances (IEI)—An integrative psychiatric perspective. Toxicol Lett 2007; 171:1-9. [PMID: 17548174 DOI: 10.1016/j.toxlet.2007.04.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Revised: 04/24/2007] [Accepted: 04/26/2007] [Indexed: 11/30/2022]
Abstract
Idiopathic environmental intolerances (IEI) - formerly multiple chemical sensitivities (MCS) - are characterized by diffuse symptoms reported after exposure to low doses of everyday chemicals. Previous theories about the origin of IEI have emphasized either biological or psychological factors, neglecting a probable interplay. Many have suggested classifying IEI as a somatoform or an anxiety disorder, irrespective of some incongruities. By focusing on dysfunctional cognitions we discuss obvious parallels of IEI with somatoform disorders, and also indicate overlaps with anxiety and delusional disorders. To propose a hypothetical psycho-neurobiological basis of IEI, recent evidence about cortically represented symptoms in the absence of peripheral stimuli is briefly summarized. We conclude that IEI can serve as an illustrative example for the impact of cognitive, representational processes in symptom generation.
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Affiliation(s)
- C Hausteiner
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Germany.
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Hausteiner C, Bornschein S, Förstl H, Zilker T. Multiple Chemikaliensensitivität (MCS). Monatsschr Kinderheilkd 2007. [DOI: 10.1007/s00112-005-1182-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Deubel M, Ring J, Darsow U, Willi R, Pfab F, Ellwanger J, Sander I, van Heemst R, de Jong L, Houba R, Idema R, Belderbos H, Zahradnik E, Brüning T, Raulf-Heimsoth M, Eben R, Bauer C, Ruëff F, Ruzicka T, Przybilla B, Pföhler C, Hasselmann D, Müller C, Tilgen W, Buters J, Behrendt H, Zilker T. Kasuistiken. Allergo J 2007. [DOI: 10.1007/bf03370561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Thiermann H, Szinicz L, Eyer P, Felgenhauer N, Zilker T, Worek F. Lessons to be learnt from organophosphorus pesticide poisoning for the treatment of nerve agent poisoning. Toxicology 2006; 233:145-54. [PMID: 17161895 DOI: 10.1016/j.tox.2006.11.056] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 10/17/2006] [Accepted: 11/13/2006] [Indexed: 10/23/2022]
Abstract
The increasing threat of nerve agent use for terrorist purposes against civilian and military population calls for effective therapeutic preparedness. At present, administration of atropine and an oxime are recommended, although effectiveness of this treatment is not proved in clinical trials. Here, monitoring of intoxications with organophosphorus (OP) pesticides may be of help, as their actions are closely related to those of nerve agents and intoxication and therapy follow the same principles. To this end, the clinical course of poisoning and the effectiveness of antidotal therapy were investigated in patients requiring artificial ventilation being treated with atropine and obidoxime. However, poisoning with OP pesticides shows extremely heterogeneous pictures of cholinergic crisis frequently associated with clinical complications. To achieve valuable information for the therapy of nerve agent poisoning, cases resembling situations in nerve agent poisoning had to be extracted: (a) intoxication with OPs forming reactivatable OP-AChE-complexes with short persistence of the OP in the body resembling inhalational sarin intoxication; (b) intoxication with OPs resulting rapidly in an aged OP-AChE-complex resembling inhalational soman intoxication; (c) intoxications with OPs forming a reactivatable AChE-OP complex with prolonged persistence of the OP in the body resembling percutaneous VX intoxication. From these cases it was concluded that sufficient reactivation of nerve agent inhibited non-aged AChE should be possible, if the poison load was not too high and the effective oximes were administered early and with an appropriate duration. When RBC-AChE activity was higher than some 30%, neuromuscular transmission was relatively normal. Relatively low atropine doses (several milligrams) should be sufficient to cope with muscarinic symptoms during oxime therapy.
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Affiliation(s)
- H Thiermann
- Bundeswehr Institute of Pharmacology and Toxicology, Neuherbergstr. 11, 80937 Munich, Germany.
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Abstract
Confirmed cases of poisoning resulting from the ingestion of Colchicum autumnale in mistake for Allium ursinum were analysed retrospectively. The study included 32 patients between 27 and 90 years. The severity of the intoxication was graded on the basis of the poisoning severity score (PSS). All the patients developed diarrhea and/or vomiting after a latency period of between 2 and 24 h. All those patients with a latency of > 9 h suffered only mild poisoning. If the leaves were boiled before being eaten, 64% of the patients suffered moderate, severe or fatal poisoning; when the leaves were eaten raw, only 33%. It is presumed that heating may promote the liberation of colchicines from the plant. Eight of the nine patients with severe or fatal poisoning were older than 65 years. A possible cause of the more serious course in the elderly may be a decrease in renal clearance. In addition, a diminished sense of smell may allow the absence of the typical garlic smell and taste of Allium ursinum to go unrecognised.
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Affiliation(s)
- M Hermanns-Clausen
- Hermanns-Clausen Leiterin der Vergiftungs-Informations-Zentrale (VIZ), Univ.Klinikum Freiburg.
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Eyer F, Pfab R, Zilker T. [Lethal sepsis and multi-organ failure after accidental injection of urine in a drug addict]. Dtsch Med Wochenschr 2005; 130:1258-60. [PMID: 15889322 DOI: 10.1055/s-2005-868710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 33-year-old drug addict injected accidentally into the femoral vein 5 ml urine (kept in the refrigerator for 1 week for unanticipated drug-screening) which she mis-took for methadone. Soon after injection she was found confused with shivering. On admission she had a blood pressure of 90/60 mmHg, heart rate of 120/min and fever of 40 degrees C. INVESTIGATIONS Laboratory tests showed consumption coagulopathy (DIC) as well as leukopenia. Blood cultures were positive for E.coli and Klebsiella pneumoniae. Infection with hepatitis C and HIV was excluded. Echocardiography revealed good ventricular function without signs of endocarditis. DIAGNOSIS AND TREATMENT The patient developed a fulminant Gram-negative sepsis with DIC and multi-organ failure. She was intubated and mechanically ventilated. Acute renal failure required haemodialysis and ultrafiltration. Septic shock was treated with fluids and high doses of vasopressors. DIC was effectively treated with tranexamic acid, PPSB complex and fresh frozen plasma. The further course was complicated by septic emboli to the myocardium, liver, kidney and spleen. Laparotomy because of an acute abdomen revealed perforation of terminal ileum (mainly due to ischemic bowel lesions) requiring partial resection. The patient was weaned on day 18 with an initially uneventful further course. On day 25 the patient had a cardiac arrest with at first successful resuscitation but electromechanical dissociation proved fatal on day 26. CONCLUSION Although serious systemic inflammation associated with i. v.-injection in drug addicts is rare, one has to be aware of severe complications with septic emboli. To our knowledge it is the first published case of i. v.-injection of urine followed by sepsis and multi-organ failure. Aggressive interdisciplinary treatment is required.
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Affiliation(s)
- F Eyer
- Toxikologische Abteilung der II. Medizinischen Klinik, Klinikum rechts der Isar, Technische Universität München.
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Abstract
HISTORY A 71-year-old previously healthy man consumed a mushroom meal containing Amanita phalloides, which he had confused with Agaricus campestris. Approximately 8 hours later, typical gastrointestinal symptoms began with copious loss of fluids. Treatment with penicillin G was initiated followed by a continuous silibinin infusion before the patient was transferred to our toxicological department. Other than a transient tachycardia and diffuse pain on abdominal palpation clinical examination was without abnormal findings. INVESTIGATIONS Laboratory findings showed severe hepatic damage with 100-fold increased transaminases, elevation of serum creatinine, hyperbilirubinemia and a serious disturbance of coagulation. Infection with HIV, hepatitis- and CMV as well as pathogenic enteric bacteria and antibiotic-associated pseudo-membranous colitis were excluded. 11 days after the mushroom meal x-ray of abdomen showed a 6 cm dilatation of the small intestine and an 8 cm dilatation of the colon. DIAGNOSIS AND TREATMENT Although clinical condition and laboratory findings nearly fulfilled transplantation criteria, hepatic injury resolved during intensive care therapy. Intractable diarrhea, dilatation of the intestine on x-ray as well as other findings met criteria of toxic megacolon. Therapy with antibiotics and systemic steroids was ineffective, so the patient needed decompression by a catheter, which was placed by colonoscopy. 30 days after the serious amanita poisoning complicated by development of toxic megacolon, the patient's condition resolved without sequelae and he was discharged. CONCLUSIONS In addition the well known complications of amanita-poisoning, such as hepatic failure, encephalopathy and multi-organ failure, involvement of other organs like bone marrow, pancreas, kidney and gastrointestinal tract (except for the initial cholera-like gastroenteritis) are not well documented in the literature. Uncommon complications like toxic megacolon require an empirical approach.
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Affiliation(s)
- F Eyer
- Toxikologische Abteilung der II. Medizinischen Klinik, Klinikum rechts der Isar - Technische Universität München, München, Germany.
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Hausteiner C, Bornschein S, Förstl H, Zilker T. [Multiple chemical sensitivity. Is the patient suffering as a result of environmental pollutants or psychological problems?]. MMW Fortschr Med 2003; 145:31-4. [PMID: 14526571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Multiple chemical sensitivity (MCS) poses a medical challenge. Proposed etiologies are as numerous as they are contradictory, direct and indirect costs are high, and patient suffering considerable. In the absence of objective diagnostic criteria, estimation of its prevalence is difficult. Nevertheless, establishment of the diagnosis is frequently strikingly uncritical. We support an holistic approach that gives consideration both to psychological and physical aspects, as well as taking account of the high level of comorbidity, and we warn against "over-diagnosis". Therapeutical approaches should consider carefully the risk of avoidance and social withdrawal.
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Affiliation(s)
- C Hausteiner
- Toxikolog. Abt. der II. Med. Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU München.
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Bornschein S, Hausteiner C, Förstl H, Zilker T. [Psychiatric aspects of multiple chemical sensitivity (MCS)]. VERSICHERUNGSMEDIZIN 2002; 54:163-7. [PMID: 12491564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Patients with multiple chemical sensitivity (MCS) react to low levels of common environmental chemicals with various health complaints. The etiology and pathogenesis of MCS is not clear. Objective criteria for diagnosis are lacking. Usually there are no pathological somatic findings, while psychiatric morbidity is considerably high. Somatoform, mood and anxiety disorders are diagnosed most frequently. A subgroup of MCS patients may suffer from a special form of somatoform disorders related to the environment. Critics of a psychogenic model of MCS argue that psychiatric diagnoses are descriptive, and causality can not be derived from them. However, clinicians are expected to evaluate the most probable cause of the complaints and give therapeutic recommendations. There are promising therapeutic concepts for somatoform and other psychiatric disorders, but not for MCS. Double-blind challenge tests, but also therapy evaluation studies could contribute to a better understanding of the pathogenesis of MCS in the future.
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Affiliation(s)
- S Bornschein
- Toxikologischen Abteilung der II. Medizinischen Klinik und Poliklinik, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technischen Universität München
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Abstract
BACKGROUND An increasing number of individuals with diverse health complaints are currently seeking help in the field of environmental medicine. Multiple chemical sensitivity (MCS) or idiopathic environmental intolerances (IEI) is defined as an acquired disorder with multiple recurrent symptoms associated with environmental chemicals in low concentrations that are well tolerated by the majority of people. Their symptoms are not explained by any known psychiatric or somatic disorder. METHOD Within a 2-year period we examined 264 of 267 consecutive patients prospectively presenting to a university based out-patient department for environmental medicine. Patients underwent routine medical examination, toxicological analysis and the structured clinical interview for DSM-IV psychiatric disorders (SCID). RESULTS Seventy-five per cent of the patients met DSM-IV criteria for at least one psychiatric disorder and 35% of all patients suffered from somatoform disorders. Other frequent diagnoses were affective and anxiety disorders, and dependence or substance abuse. In 39% a psychiatric disorder, in 23% a somatic condition and in 19% a combination of the two were considered to provide sufficient explanation of the symptoms. Toxic chemicals were regarded as the most probable cause in only five cases. The suspected diagnosis of MCS/IEI could not be sustained in the vast majority of cases. CONCLUSION This investigation confirms previous findings that psychiatric morbidity is high in patients presenting to specialized centres for environmental medicine. Somatoform disorders are the leading diagnostic category, and there is reason to believe that certain 'environmental' or MCS patients form a special subgroup of somatoform disorders. In most cases, symptoms can be explained by well-defined psychiatric and medical conditions other than MCS, which need specific treatment. Further studies should focus on provocation testing in order to find positive criteria for MCS and on therapeutic approaches that consider psychiatric aspects.
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Affiliation(s)
- S Bornschein
- Psychiatric Clinic and Department of Toxicology, I, Medical Clinic, Technical University of Munich, Germany
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Felgenhauer N, Zilker T. [Emergencies in general practice. Acute poisoning with medicinal drugs]. MMW Fortschr Med 2002; 144:42-5. [PMID: 12116553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- N Felgenhauer
- Toxikologische Abt., II. Medizinischen Klinik, Klinikum rechts der Isar, Ismaninger Str. 22, D-81675 München.
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Werner E, Roth P, Höllriegl V, Hansen C, Kaltwasser JP, Giussani A, Cantone MC, Greim H, Zilker T, Felgenhauer N. Assessment of intestinal absorption of trace metals in humans by means of stable isotopes. Isotopes Environ Health Stud 2002; 38:23-31. [PMID: 12219989 DOI: 10.1080/10256010208033306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study is aimed to demonstrate the feasibility of stable isotopes for the assessment of reliable data on fractional intestinal absorption of trace metals in healthy humans. Among the various methods available, the double isotope technique, i.e. one isotope given orally together with the test substance to be investigated and another isotope injected intravenously to correct for retention and endogenous excretion of the particular trace metal, provides quantitative figures of intestinal absorption at reasonable expenses with regard to costs for materials and number of samples to be evaluated. The trace metals exemplarily included in this study, i.e. iron, cobalt and molybdenum show diverging relations between absorbed fractions and amounts administered which are indicative for different regulatory mechanisms of their body content. Food ligands influence the fractional absorption significantly so that the uptake from a composite meal cannot be derived from results on uptake from particular foodstuffs. Therefore, validated data on the behaviour of intestinal absorption will significantly contribute to a better understanding of human trace metal metabolism.
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Affiliation(s)
- E Werner
- GSF-National Research Center for Environment and Health, Institute of Radiation Protection, Oberschleissheim, Germany.
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Abstract
Idiopathic environmental intolerances (IEI)/multiple chemical sensitivity (MCS) is characterized by various somatic symptoms which cannot be explained organically, but are attributed to the influences of toxic environmental chemicals in low, usually harmless doses. In the absence of a widely accepted definition of IEI, contradictory aetiological hypotheses and therapeutic suggestions are discussed. Some authors doubt the existence of IEI/MCS as a disease entity of its own. The label IEI does not implicate neither a diagnosis of somatic disease nor that it is caused by an avoidable exposure. Many IEI patients suffer from psychiatric diseases. A majority of them can be diagnosed as somatoform disorders. Consequently, psychiatric therapies could be effective. This review describes the current knowledge about IEI/MCS, outlines a diagnostic algorithm and a psychotherapeutic concept for variants of IEI understood as a somatoform disorder.
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Affiliation(s)
- S Bornschein
- Department of Toxicology, II. Medical Department, Technische Universität München, Germany.
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Grasshoff C, Thiermann H, Gillessen T, Zilker T, Szinicz L. Internal standard high-performance liquid chromatography method for the determination of obidoxime in urine of organophosphate-poisoned patients. J Chromatogr B Biomed Sci Appl 2001; 753:203-8. [PMID: 11334332 DOI: 10.1016/s0378-4347(00)00543-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Obidoxime is an antidote approved for reactivation of inhibited acetylcholinesterase in organophosphate poisoning. HPLC methods were described for its determination in blood or aqueous solutions but not for the determination in urine. Since data for renal obidoxime excretion ranged from 2.2 to 84% of administered dose in healthy volunteers depending on the route of administration and little is known about pharmacokinetics of obidoxime in severely intoxicated patients we developed an internal standard (HI 6) reversed-phase HPLC method for determining obidoxime in urine. The mobile phase consisted of methanol, the counter ion 1-heptane sulfonic acid and tetrabutylammonium phosphate, the stationary phase involved a 5 microm reversed-phase column (125x4 mm). Obidoxime was detected spectrophotometrically at 288 nm. The limit of quantification (LOQ) was 1 microM, the limit of detection (LOD) 0.5 microM. Linear calibration curves were obtained in a concentration range from 1 to 1000 microM. Intra- and inter-day precision C.V.s were below 4%. Accuracy was 95.9% in the LOQ range. Using this method, we were able to quantify obidoxime in urine of an organophosphate poisoned patient. Based on this data we calculated that 58% of the administered dose was excreted in the urine.
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Affiliation(s)
- C Grasshoff
- Institut fuer Pharmakologie und Toxikologie, Garching-Hochbrueck, Germany
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31
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Felgenhauer N, Zilker T, Worek F, Eyer P. Intoxication with huperzine A, a potent anticholinesterase found in the fir club moss. J Toxicol Clin Toxicol 2001; 38:803-8. [PMID: 11192470 DOI: 10.1081/clt-100102396] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Herbs from Lycopodium are generally reputed to be nontoxic and are occasionally used for preparing a salubrious tea. In Europe, the common Lycopodium clavatum can be easily confused with Lycopodium selago, the fir club moss. CASE REPORT We report 2 patients who drank a tea, erroneously prepared from dried herbs of Lycopodium selago, which resulted in sweating, vomiting, diarrhea, dizziness, cramps, and slurred speech. These symptoms were suggestive of a cholinergic mechanism. To elucidate the active principle, aqueous extracts of Lycopodium selago were checked for their suspected anticholinesterase activity using human erythrocytes as an enzyme source in a modified Ellman assay. The extracts did exhibit significant anticholinesterase activity. The anticholinesterase(s) were most effectively extracted with dichloromethane and isolated by high-performance liquid chromatography. The major compound with anticholinesterase activity co-chromatographed with authentic huperzine A, but had a 2-3-fold higher inhibitory potency than the racemic standard. The amount of huperzine A found in the Lycopodium selago sample used for the tea preparation was calculated to be sufficient for a relevant acetylcholinesterase inhibition. CONCLUSION The signs and symptoms of Lycopodium selago poisoning are consistent with the anticholinesterase activity of huperzine A and should favorably respond to atropine therapy. This report demonstrates once more that laymen should not be encouraged to gather their remedies from "Mother Nature" without advanced botanical knowledge.
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Affiliation(s)
- N Felgenhauer
- Toxikologische Abteilung der II. Med. Klinik, Klinikum r.d. Isar, TU München, Germany.
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Bornschein S, Hausteiner C, Zilker T, Bickel H, Förstl H. [Psychiatric and somatic morbidity of patients with suspected multiple chemical sensitivity syndrome (MCS)]. Nervenarzt 2000; 71:737-44. [PMID: 11042869 DOI: 10.1007/s001150050658] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Multiple chemical sensitivity (MCS) or idiopathic environmental intolerance (IEI) is understood as an acquired disorder with multiple recurrent symptoms that cannot be traced to any well-known medical or psychiatric condition and is associated with diverse environmental influences that are well tolerated by the majority of people. In a prospective study, we investigated 120 consecutive patients admitted a university-based outpatient department for environmental medicine during 1 year. Apart from routine medical examination and special toxicological diagnostic procedures, a structured clinical interview for DSM-IV psychiatric disorders was performed with every patient. At least one psychiatric diagnosis was found in 100 patients. The diagnostic criteria for somatoform disorders were filled by 53 patients. We found lifetime or current affective disorders in 39 patients, anxiety disorders in 29, and substance dependency or abuse in 25. In 16 patients, personality disorders were diagnosed. Nine suffered from psychotic disorders. This is the largest prospective study with standardized psychiatric diagnostic methods concerning psychiatric morbidity and MCS. The data show that many patients with environmental health problems obviously suffer from somatoform disorders but also from other, well-known psychiatric conditions.
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Affiliation(s)
- S Bornschein
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technischen Universität München
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33
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Zilker T. [Poisoning with ecstasy or cocaine. Why no beta blockers?]. Internist (Berl) 1999; 40:981. [PMID: 10577008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- T Zilker
- II. medizinische Klinik und Poliklinik, München
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Speckl IM, Hallbach J, Guder WG, Meyer LV, Zilker T. Opiate detection in saliva and urine--a prospective comparison by gas chromatography-mass spectrometry. J Toxicol Clin Toxicol 1999; 37:441-5. [PMID: 10465240 DOI: 10.1081/clt-100102434] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
UNLABELLED There is an increasing interest in saliva as an alternative analytic body fluid. OBJECTIVE This study sought to determine the correlation of opiates analyzed in saliva and corresponding urine. METHODS A total of 130 adequate and 24 inadequate samples were collected from patients participating in drug withdrawal therapy. To obtain saliva from the oral cavity, a newly developed collection device (Clin Rep), consisting of a treated cotton roll and a centrifugation vial with a filter inset, was tested. For the preparation of a purified solution of urine, liquid extraction was used. Solid phase extraction was utilized to prepare the saliva samples. For the detection by gas chromatography-mass spectrometry, an appropriate derivatization was necessary using N-methyl-N-(trimethylsilyl)trifluoroacetamide. The retention times were compared with defined standard solutions. The obtained mass spectra showed a characteristic fragmenting pattern and offered a reliable identification. RESULTS The concordance of the analytic results of the saliva samples with urine was 93% for a decision limit of 100 ng/mL and 98% for a decision limit of 300 ng/mL (DHHS opiate cutoff) in urine. CONCLUSIONS Saliva, of adequate amount in 85% of samples, may be appropriate for analysis of drugs of abuse.
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Affiliation(s)
- I M Speckl
- Krankenhaus München-Bogenhausen, München, Germany
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35
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Zilker T. [Alcohol withdrawal syndrome and delirium tremens. Diagnosis and therapy]. MMW Fortschr Med 1999; 141:26-30. [PMID: 10726125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The alcohol withdrawal syndrome can be classified into three degrees of severity on the basis of the symptomatology, autonomic withdrawal, predelirium and delirium tremens. In American literature the severity of withdrawal is recorded using the CIWA-A scale (Clinical Institute Withdrawal Assessment--Alcohol). The pathophysiological causes lie in an imbalance between the inhibitory and excitatory neurotransmitters after giving up alcohol. This results in predomination by the excitatory system. Therapeutic intervention is possible here. Clomethiazole has effective sedative actions, stabilises the autonomic nervous system, and is an anticonvulsant. It is the drug of choice for autonomic withdrawal and predelirium. The benzodlazepines have a similar effect, but cannot be controlled so accurately. Carbamazepine can prevent withdrawal convulsions and progression of delirium. Clonidine acts on autonomic withdrawal and, together with neuroleptics and benzodiazepines, is easy to use parenterally for delirium tremens, while parenteral clomethiazole harbours dangers.
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Affiliation(s)
- T Zilker
- Toxikologische Abteilung II, Med. Klinik der Technischen Universität, München
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Abstract
Considering the various microscopic reactions as well as toxicokinetic and pharmacokinetic principles in therapy of organophosphate poisoning, the administration of obidoxime by an initial bolus dose followed by continuous infusion appears rational. Using this protocol, six patients each with parathion or oxydemeton methyl poisoning were treated. In parathion poisoning, reactivation was possible up to 7 days. At paraoxon concentrations > 0.1 microM obidoxime only partially reactivated acetylcholinesterase (AChE) of erythrocytes in vivo although reactivation could be assessed in vitro, which roughly fitted theoretical calculations. AChE-inhibitory material was detected up to 5 days. Cholinergic signs soon subsided when AChE was above 20% of normal, and atropine plasma levels could be kept below 7 ng/ml. In one patient brain damage persisted. Oxydemeton methyl poisoning responded to obidoxime therapy only when the oxime was instituted shortly after poisoning. Out of six patients one died. No intermediate syndrome and no signs of permanent hepatic dysfunction were found in the 12 patients.
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Affiliation(s)
- H Thiermann
- Institut für Pharmakologie und Toxikologie, Sanitätsakademie der Bundeswehr, Garching/Hochbrück, Germany
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Zilker T, Classen M. [Diagnosis and therapy of addictive diseases]. Internist (Berl) 1999; 40:581-2. [PMID: 10420308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Affiliation(s)
- N Felgenhauer
- Toxikologische Abteilung der II. Medizinischen Klinik des Klinikums rechts der Isar der Technischen Universität, München
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39
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Affiliation(s)
- R Pfab
- Toxikologische Abteilung, II. Medizinischen Klinik der Technischen Universität, München
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40
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Blaschko S, Zilker T, Förstl H. [Idiopathic environmental intolerance (IPI)--formerly multiple chemical sensitivity (MCS)--from the psychiatric perspective]. Fortschr Neurol Psychiatr 1999; 67:175-87. [PMID: 10327313 DOI: 10.1055/s-2007-993995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The term "idiopathic environmental intolerances" (IEI)/"multiple chemical sensitivities" (MCS) is used to describe a complex of heterogeneous somatic symptoms without a diagnosable organic disease. Symptoms are believed to be triggered by exposure to low levels of environmental chemicals that are usually well tolerated by the general population. There is no widely accepted definition for the phenomenon. A number of contradictory etiologic hypotheses and therapeutic concepts are discussed. One of the crucial questions is whether IEI/MCS should be understood as an own entity of disease. It has been demonstrated that a majority of patients with IEI/MCS meet diagnostic criteria for psychiatric diseases. Most frequently, somatoform, affective and anxiety disorders can be diagnosed. Therefore, psychiatric and psychotherapeutic therapy seems appropriate. The present paper provides a review of the different case definitions, etiologic and therapeutic concepts and of studies examining the frequency of psychiatric morbidity in patients with IEI/MCS. Additionally, a diagnostic algorithm and a concept of behavioral therapy for IEI/MCS patients with somatoform disorders are described.
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Affiliation(s)
- S Blaschko
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technischen Universität München
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41
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Pfab R, Hirtl C, Zilker T. Opiate detoxification under anesthesia: no apparent benefit but suppression of thyroid hormones and risk of pulmonary and renal failure. J Toxicol Clin Toxicol 1999; 37:43-50. [PMID: 10078159 DOI: 10.1081/clt-100102407] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The new technique for opiate detoxification using anesthesia and high, repetitive doses of opiate-antagonists claims to detoxify addicts without withdrawal symptoms within 24-48 hours. We studied the method with 12 opiate addicts (5 L-polamidone, 4 dihydrocodeine, 3 heroin), using general anesthesia and the antagonists naloxone 0.5 mg/kg and naltrexone > 150 mg. Objective and subjective withdrawal symptoms were measured until urine was free of drugs and patients had no withdrawal symptoms. Thyroid hormones were measured before, during, and after the anesthesia period. RESULTS All patients had moderate to severe opiate withdrawal symptoms. No detoxification was finished within 48 hours. The dihydrocodeine subjects were compared with conventionally detoxified controls; no difference was seen. The method suppressed thyroid hormones TT3, TT4, and TSH. The study was terminated because of side effects: 1 pulmonary failure and 2 renal failures. All patients survived without sequelae. CONCLUSION There is no obvious benefit from this method, whereas the risks are high.
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Affiliation(s)
- R Pfab
- Toxikologische Abteilung, Medizinische Klinik, München, West Germany.
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Wilbert-Lampen U, Seliger C, Zilker T, Arendt RM. Cocaine increases the endothelial release of immunoreactive endothelin and its concentrations in human plasma and urine: reversal by coincubation with sigma-receptor antagonists. Circulation 1998; 98:385-90. [PMID: 9714087 DOI: 10.1161/01.cir.98.5.385] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cocaine-associated vascular events are not completely explained by adrenergic stimulation. The purposes of this study were to investigate whether vasoconstrictive endothelin-1 is released by cocaine and to elucidate the mechanisms involved. METHODS AND RESULTS Endothelin-1 was measured by radioimmunoassay and high-performance liquid chromatography (1) in the supernatant of porcine aortic endothelial cells after treatment with cocaine (10(-7) to 10(-4) mol/L) and a sigma-receptor antagonist, haloperidol (10(-6) mol/L) or ditolylguanidine (10(-5) mol/L) and (2) in plasma and urine of 12 cocaine-intoxicated patients and 13 healthy control subjects. Radioligand binding assays were performed on endothelial membrane preparations. In cell culture, cocaine significantly increased endothelin accumulation above baseline at 3 to 24 hours; endothelin release rates per hour increased dose-dependently, reaching a plateau of 175+/-23% of control at hour 4 to 5. Coincubation of cocaine with haloperidol or ditolylguanidine abolished or reduced cocaine-induced endothelin release. Endothelial membrane preparations specifically and displaceably bound the highly selective sigma-ligand [3H]ditolylguanidine (25x10(-9) mol/L), with 1400 binding sites estimated per cell. Endothelin-1 levels in plasma (22.7+/-5.6 versus 7.3+/-0.8 pmol/L) and urine (41.5+/-10.1 versus 12.7+/-3.8 pmol/L) of cocaine-intoxicated patients were significantly increased compared with control values. CONCLUSIONS The data suggest that cocaine increases the endothelin-1 release in vitro and in vivo. The cocaine-induced vasoconstriction/vasospasm may therefore be facilitated by the release of endothelin-1. Cocaine appears to be an exogenous stimulator at endothelial sigma-receptors. The endogenous ligands of this antiopioid system may prove to play a role in vasospastic angina, acute myocardial infarction, and sudden cardiac death.
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Affiliation(s)
- U Wilbert-Lampen
- Medizinische Klinik and Poliklinik I, Klinikum Grosshadern, Ludwig-Maximilian-University, Munich, Germany
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Zilker T, Felgenhauer N, Hibler A, Pfab R, Thiermann H, Worek F, Eyer P. Factors influencing the efficacy of obidoxime in organophosphate pesticides poisoning. Przegl Lek 1998; 54:662-4. [PMID: 9478082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Kleber JJ, Zilker T. [Adder bites in humans]. Tierarztl Prax Ausg K Kleintiere Heimtiere 1998; 26:95-100. [PMID: 9587980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In Germany the common viper (Vipera berus) and very seldom Vipera aspis are the only in freedom normally existing snakes. In general, bites by the common viper cause slight local symptoms, sometimes strong swellings of the extremities, but only rarely severe perilous general symptoms such as shock and angioneurotic edema. Mortal progresses despite of medical treatment are the exceptions. The most important therapeutic measure is the immobilization of the bitten extremity and the transport in a recumbent position to the next surgeon or clinic. The perilous shock and the angioneurotic edema often react on the administration of antihistaminica and corticosteroids, whereas the increase of the swelling of the extremity cannot be influenced by this treatment. The corresponding antisera have an advantageous and fast effect on all general symptoms and seem to favourably influence the swelling of the extremities. Because of the allergic reactions against the sera from horses, which do not occur seldom, in severe cases only Beritab--which is not yet admitted in Germany--with purified Fab-fragment antibodies from sheep should be used.
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Affiliation(s)
- J J Kleber
- Toxikologischen Abteilung, Technischen Universität München
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Thiermann H, Mast U, Klimmek R, Eyer P, Hibler A, Pfab R, Felgenhauer N, Zilker T. Cholinesterase status, pharmacokinetics and laboratory findings during obidoxime therapy in organophosphate poisoned patients. Hum Exp Toxicol 1997; 16:473-80. [PMID: 9292288 DOI: 10.1177/096032719701600809] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
1 The effectiveness of oxime therapy in organophosphate poisoning is still a matter of debate. It appears, however, that the often cited ineffectiveness of oximes may be due to inappropriate dosing. By virtue of in vitro findings and theoretical considerations we concluded in the preceding paper that oximes should preferably be administered by continuous infusion following an initial bolus dose for as long as reactivation of inhibited acetylcholinesterase (AChE) can be expected. This conclusion has called for a clinical trial to evaluate such oxime therapy on the basis of objective parameters. 2 Before transfer to the intensive care unit (ICU), 5 patients received primary care by an emergency physician. In the ICU, atropine sulphate was administered i.v. upon demand according to the endpoints: no bronchorrhoea, dry mucous membranes, no axillary sweating, heart rate of about 100/min. Obidoxime (Toxogonin) was given as an i.v. bolus (250 mg) followed by continuous infusion of 750 mg/24 h. 3 Intoxication and therapy were monitored by determining erythrocyte AChE (eryAChE) activity, reactivatability of the patient's eryAChE ex vivo, plasma cholinesterase activity, the presence of AChE inhibiting compounds, as well as the concentrations of obidoxime and atropine in plasma. 4 Obidoxime was effective in life-threatening parathion poisoning, in particular when the dose absorbed was comparably low. In mega-dose poisoning, net reactivation was not achieved until several days after ingestion, when the concentration of active poison in plasma had declined. Reactivatability in vivo lasted for a longer period than expected from in vitro experiments. 5 Obidoxime was quite ineffective in oxydemetonmethyl poisoning, when the time elapsed between ingestion and oxime therapy was longer than 1 day. When obidoxime was administered shortly after ingestion (1 h) reactivation was nearly complete. 6 Obidoxime levels of 10-20 microM were achieved by our regimen, and atropine could rapidly be reduced to approx. 20 microM, as attained by continuous infusion of 1 mg atropine sulphate/h. Maintenance of the desired plasma levels was not critical even when renal function deteriorated. 7 Signs of transiently impaired liver function were observed in patients who showed transient multiorgan failure. In the present stage of knowledge, we feel it advisable to keep the plasma concentration of obidoxime at 10-20 microM, although the full reactivating potential of obidoxime will not then be exploited. Still, the reactivation rate, with an apparent half-time of some 3 min, is twice that estimated for a tenfold higher pralidoxime concentration.
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Affiliation(s)
- H Thiermann
- Walther-Straub-Institut für Pharmakologie und Toxikologie, Ludwig-Maximilians-Universität München, Germany
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Martius P, Hüther R, Zilker T. [A case of malignant neuroleptic syndrome. Case report]. Nervenarzt 1996; 67:418-21. [PMID: 9005355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report on a woman patient with organophosphate poisoning resulting from a psychotically motivated suicide attempt. After detoxification and during treatment with haloperidol and levomepromazine, she developed acute malignant neuroleptic syndrome (MNS) in which dyspnea requiring assisted ventilation was the main symptom. Discontinuation of the neuroleptics was enough to effect sufficient recovery. With this case report, we would first like to emphasize that MNS can evolve within a very short time into a severe and life-threatening situation requiring intensive medical care, and secondly to illustrate the implications of organophosphate poisoning and the consequent cholinesterase blocking far the differential diagnosis of MNS.
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Affiliation(s)
- P Martius
- Psychiatrische Abteilung, Technischen Universität, Klinikum Rechts der Isar, München
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Abstract
CASE REPORT A 44-year-old man ingested 83 mg/kg Thiomersal. He developed gastritis, renal tubular failure, dermatitis, gingivitis, delirium, coma, polyneuropathy and respiratory failure. Treatment was symptomatic plus gastric lavage and the oral chelating agents dimercaptopropane sulfonate and dimercaptosuccinic acid. The patient recovered completely. Maximum mercury concentrations were blood 14 mg/L, serum 1.7 mg/L, urine 10.7 mg/L, and cerebrospinal fluid 0.025 mg/L. Mercury concentration in blood declined with two velocities: first with half-time 2.2 days, then with half-time 40.5 days. The decline of mercury concentration in blood, urinary mercury excretion, and renal mercury clearance were not substantially influenced by chelation therapy.
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Affiliation(s)
- R Pfab
- Walther-Straub-Institut für Pharmakologie und Toxikologie, Universität München, Germany
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Zachoval R, Günther C, Scheurlen C, Klüppelberg UG, Zilker T, Pape GR. [A 27-year old patient with watery diarrhea, nausea and vomiting 10 hours after eating a mushroom dish. Interdisciplinary liver transplantation team of the Grosshadern Clinic]. Internist (Berl) 1994; 35:385-91. [PMID: 8200763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- R Zachoval
- Medizinische Klinik II, Klinikum Grosshadern, Ludwig-Maximilians-Universität, München
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Zilker T, Schaupp G. [Psychological processing of environmental anxiety. Dilemma of physicians--insecurity of patients]. Fortschr Med 1993; 111:211-213. [PMID: 8514222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- T Zilker
- Toxikologische Abteilung, Isar der Technischen Universität München
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Abstract
Most survivors of paraquat intoxication go on to develop fibrosis of the lung leading to death within a few weeks. The pathogenic effects of paraquat are based on the formation of oxygen free radicals. A cascade reaction occurs at the cell membrane which is damaged and cell integrity is destroyed. Fibroblasts migrate into the damaged region leading to the laying down of collagen and subsequent fibrosis. Currently paraquat intoxication is treated with gastrointestinal lavage, haemoperfusion and haemodialysis with mixed results. Artificial respiration with low percentage of inspired oxygen is instituted in order to decrease the possible release of oxygen radicals. However, in most cases, developing fibrosis prevents this treatment continuing and requires increased concentrations of inspired O2 and increased ventilation pressure. The combination of increased FiO2 and barotrauma leads to a vicious circle of parenchymal lung damage. In this study we present a treatment designed to avoid the development of lung fibrosis using total exclusion of segments of the lung from external ventilation. Exclusion from external ventilation was performed in animal experiments by instillation of Ethibloc, an amino acid glue, in one main bronchus to create an atelectasis. In different experimental groups this procedure was performed before and after intraperitoneal intoxication with paraquat. Four to twelve days later the experimental animals were sacrified and the ventilated lungs and the atelectatic lungs were compared. The ventilated lungs showed dose-dependent damage to the alveolar epithelium and gross interstitial oedema. In some cases fibrosis was seen. The atelectatic parts of the lung were not different from the control group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F Fogt
- Toxikologische Abteilung, II, Medizinische Klinik, Technische Universitaet Muenchen, West Germany
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