A case of merbromin (Mercurochrome) intoxication possibly resulting in aplastic anemia

A patient is described who appeared to be suffering from mercury intoxication caused by local application of merbromin to an operation wound and who developed aplastic anemia, which we ascribed to merbromin.

Accidental intrathecal mercury application

The authors present a case of accidental intrathecal mercury application. A 69-year-old white woman was admitted to our department with suspected meningitis following surgery for spinal stenosis at another hospital. Postoperatively, she had developed a cerebro-spinal fluid (CSF) fistula with a subcutaneous cavity. Local wound irritation had been suspected and, unfortunately, mercury-containing disinfectant was injected into the cavity. Within 24 h the patient demonstrated acute neurological deterioration due to meningitis and encephalitis and was admitted to our clinic with suspected meningitis due to postoperative CSF fistula. Lumbar puncture revealed desinfectant-stained, non-bloody CSF, while lumbar MRI demonstrated the large lumbar subcutaneous cavity. Additionally, CSF fistula was visualized on MRI. Laboratory examination revealed extremely high mercury levels in CSF, blood and urine. Treatment consisted in insertion of a lumbar drainage to wash out the mercury. The patient underwent medical detoxication using chelating agents (DMPS: RS-2,3-dimercapto-1-propansulfonacid, DMSA: meso-2,3-dimercaptosuccinatacid). Surgery was performed in order to close the cavity and the fistula. Postoperatively, the patient was admitted to the intensive care unit and remained intubated for 3 days. Within 4 weeks after surgery, she demonstrated good recovery. Eighteen months after intoxication, polyneuropathy and slight neuropsychological deficiencies were detectable.

Efficacy of Rhizophora mangle aqueous bark extract in the healing of open surgical wounds

Thirty-seven patients with open wounds from surgical intervention of pilonidal cyst (14; 37.8%) or pilonidal fistula (23; 62.2%) were enrolled on a voluntary basis in a comparative blinded clinical trial and randomly assigned to a topical treatment with a Rhizophora mangle aqueous bark extract once a day or twice a day or mercurocrome twice a day. The efficacy of the treatments was evaluated weekly from day 10 to 12 until 6 weeks after surgery by measuring the area of the wounds by image digital planimetry and the tolerability by recording adverse effects. The initial size of the wounds was taken in consideration as covariable in the Generalized Lineal Model used. A thin dark red colored film covering the wound was observed in all the cases treated with the extract. The wound areas of the groups treated with the extract once or twice per day showed a greater reduction (P < 0.05) compared to the group treated with mercurocrome. No differences between the two regimes of application of the extract of R. mangle were observed. No subject showed any sign of adverse effects and no secondary infections were observed.

Mercurochrome as an adjunct to local preoperative preparation in children undergoing hypospadias repair

OBJECTIVE

To determine whether the local application of mercurochrome over genital skin before surgery, in addition to soap/water scrubs, can help to decrease the incidence of infection patients undergoing hypospadias repair, and thereby the incidence of fistula formation.

PATIENTS AND METHODS

The study comprised 44 consecutive boys undergoing primary or repeat surgery for hypospadias between October 1999 and April 2000. They were arbitrarily divided into two groups; group 1 received a conventional local scrub with soap/water 48 h before surgery and group 2, a conventional local scrub with soap/water was followed by a local application of 2% mercurochrome for 48 h before surgery. Both groups were comparable in age, location of the meatus and stage of repair. All patients were exposed to similar conditions during and after surgery. Urine, skin and wound swabs taken before during and after surgery were assessed microbiologically, using standard precautions. The incidence of infection and complications was then compared.

RESULTS

Mercurochrome significantly decreased local infection, especially before surgery, but its effect in decreasing fistula formation, although appreciable, was not statistically significant.

CONCLUSION

The local application of mercurochrome after a soap/water scrub for at least 48 h before surgery is a simple, economic and effective means to decrease postoperative wound infection. Future studies are needed, keeping other determinants of fistula formation constant, to evaluate its role in decreasing fistula formation in patients undergoing hypospadias repair.

[Accidental oral mercurochrome poisoning]

Neonatal mercury poisoning, especially that due to merbromin ingestion, is uncommon. We describe the case of a 10 day old newborn infant who was given mercurochrome orally for 7 days due to misunderstanding of medical instructions. Initial symptoms included loss of appetite and low weight increase. Elevated blood mercury concentrations were found. Chelating therapy with dimercaprol was initiated and the patient's evolution was good. We discuss the potential toxicity of mercury and emphasise the importance of the transmission of information by physicians, especially to the immigrant population.

Successful treatment of transient acantholytic dermatosis with systemic steroids

A sixty-year-old man, developed 2-5 mm sized, hyperemic, itchy papules, vesicles, erosions and crusts on hyperemic base on his chest, abdomen, back, gluteal region, and proximal sites of his upper and lower extremities. The direct and indirect immunoflurescence tests were negative. Histology revealed extensive acantholysis in the epidermis in the following forms: pemphigus vulgaris-like suprabasal acantholysis, Darier-like acantholytic dyskeratosis with corps ronds, Hailey-Hailey-like suprabasal clefts, and pemphigus foliaceus-like superficial acantholysis with spongiosis. Using systemic steroids, topical drying, and reepithelising therapy, the patient was cured. He was symptom-free the first, fourth, and thirteenth months after finishing steroid therapy. We review the literature and the new subdivision of the disease according to the histological and clinical features.

Evaluation of conservative therapy for exomphalos

Two management patterns were identified in 36 patients with exomphalos--primary surgical closure and initial topical therapy with delayed surgical closure. Primary surgical closure of minor exomphalos was well tolerated in 15 patients, but was associated with a high local and systemic morbidity rate in 14 patients with major defects. In contrast, initial topical therapy with silver sulphadiazine and delayed closure in seven matched patients with a major defect were well tolerated and did not prolong duration of hospitalization. Enteral feeding was more readily established and subsequent fascial closure facilitated in the conservatively treated group. It was suggested that this method should be more often considered in the management of all instances of major exomphalos.

The conservative management of exomphalos major

In 52 children with exomphalos treated over a 10 year period, the overall mortality was 31%. Death was almost invariably due to associated major congenital abnormalities. Treatment of minor exomphalos by primary closure incurred no additional mortality and minimal morbidity. Treatment of 25 children with exomphalos major by excharotics resulted in two deaths not attributable to other anomalies, one of which was a result of complications of this treatment regimen. Apart from infection, which was in general easy to control, the morbidity associated with this form of treatment was less than encountered in most reports of surgical closure.

[Omphalocele: 10-year-experience]

We review our experience of 32 cases of omphalocele treated in the last ten years. Improved neonatal intensive care unit, as well as other support care measures, allowed to extend even to the large defects the indication to radical primary repair. Our experience has supported that this is the method of choice in almost all cases. At present the surgical success depend on associated anomalies, cardiac especially (25% in our series), and on development of sepsis. Analysis of the results shows an overall mortality rate of 41% in the period 1973/1982, significantly decreased to 33% in the last five years.

[The topical treatment of large second degree burns in childhood by tanning with silvernitrate and mebromide (author's transl)]

The tanning method using 7% silvernitrate and 2% mebromide solution for second degree burns in childhood is demonstrated. The advantages of this method are described as singular and painless application of the agent, little annoyance of the patient, bactericidal effect in second degree burns, low expenses and easy medical care. The procedure of tanning is preferred in treating burn injuries of the trunk and non mobile areas of the extremities. We report on indication, procedure of tanning and results in the treatment of 129 burned children.