Gitaloxin poisoning in a child

Gitaloxin is a digitalis glycoside used for the same indications as digoxin and digitoxin. The successful outcome for a 2 1/2-year-old boy who accidentally ingested 3 mg of gitaloxin (100 times the normal therapeutic dose) is reported. At admission the child presented with irregular heart rhythm. He subsequently started vomiting, even after continuous gastric feeding. Only 48 h after ingestion of gitaloxin he became somnolent and developed bradyarrhythmia. The symptoms disappeared 96 h later; the bradyarrhythmia, however, (second-degree atrioventricular block) decreased progressively only after 120 h. The initial clinical presentation of gitaloxin poisoning may be misleading and careful observation in a pediatric intensive care unit is mandatory. A cross-reaction between the fluorescence polarization immunoassay for digitoxin and the radioimmunoassay for gitaloxin was found and was used as a helpful, but rough, estimate of the severity of gitaloxin poisoning, in the absence of a specific measurement of gitaloxin.     

Lead poisoning in a dog

A case of lead poisoning caused by ingestion of a lead roof-washer is described in a one-year-old, spayed Fox Terrier bitch, presented with nervous signs, and basophilic stippling of red blood cells. Blood concentrations of lead were in the low toxic range. Radiography of the abdomen revealed radio-dense objects in the stomach, which on gastrotomy included a lead roof-washer. Prior to removal of the foreign bodies, the dog showed remarkable improvement on non-specific symptomatic treatment alone, and recovered well after surgery, only to die unexpectedly several hours later. Concentrations of lead in the liver and kidneys were extremely high, and histology revealed typical intracellular inclusions and organ degeneration. In the light of these findings, it is suggested that all cases of suspected or confirmed lead poisoning be given specific chelation therapy.     

Autistic disorder: a review for the pediatric dentist

A combined analysis of two polymorphic enzymes, glutathione S-transferase mu (GST M1) and q (GST T1) and their implication as cancer risk factors was performed in a case-control study of lung and bladder cancers. Using a multiplex polymerase chain reaction (PCR) based method, the frequency of the homozygous deleted GSTM1 and GSTT1 genotypes was examined in 117 lung cancer patients, 67 urinary bladder cancer patients, and in a community-based sample of 248 healthy, unrelated individuals. In both cancer groups the frequency of the GSTM1 null genotype was higher in comparison with that of the control group (59% and 59.7% vs. 49.6%), but this increase did not reach statistical significance (p > 0.05). After grouping by the smoking status, among smokers in both cancer groups (62.1% in lung cancer and 71.4% in the bladder cancer group, respectively) there were statistically significantly (p < 0.05) increased frequencies of the GSTM1 deletion genotype as compared to the control group (49.6%). Smokers with absence of the GSTM1 gene were at an approximately 1.7-fold higher risk for lung cancer (odds ratio--OR = 1.67, 95% confidence interval--CI 95% = 1.0-2.7, p = 0.04) and an approximately 2.5-fold higher risk for bladder cancer (OR = 2.54, CI 95% = 1.2-5.5, p = 0.02). As related to GSTT1, our study demonstrated an overall GSTT1 effect on bladder cancer risk. Individuals with absence of the GSTT1 gene were at an approximately 2.5-fold higher risk of developing bladder cancer. In the lung cancer cases, the frequency of the putatively high risk GSTT1 null genotype was not increased as compared with controls. No effect of smoking was found on risk of lung and bladder cancer associated with the GSTT1 0/0 genotype. In combined analysis, the obtained results suggested that individuals who were both GSTM1 null and GSTT1 null may be at increased risk because they lack both enzymes. The findings suggest that the GSTM1 null genotype may be associated with susceptibility to lung and urinary bladder cancer in dependence on the exposure to carcinogens in cigarette smoke and that the GSTT1 null genotype is not a critical factor in mediating the risk of lung cancer, but may be associated with an increased susceptibility to bladder cancer.     

What on earth made you want to become a dentist?

The title, of course, came from a patient. The precise and original answer to the question has been largely overwhelmed by the vast changes in the profession over 30-odd years. The author discusses why he is glad he chose general dental practice; why it remains a career of interest, stimulus, challenge and satisfaction; and why he would commend it enthusiastically to today's school leavers.     

Detection of hydroquinone in a poisoning case

A fatality due to the ingestion of photographic developer solution containing hydroquinone is described. Hydroquinone was extracted from autopsy materials and identified using gas chromatography-mass spectrometry (GC-MS). The concentration of hydroquinone in the urine, liver, and kidney were 3.4 micrograms/mL, 0.5 and 0.2 microgram/g, respectively.     

Accidental cetirizine poisoning in a four-year-old boy

Cetirizine is a commonly used non-sedating antihistamine for the symptomatic relief of allergic reactions. Few reports exist on the result of overdose in children. We would like to report the result of a 12 fold overdose of cetirizine in a four-year-old-boy (weight 20 kg) who accidentally ingested 60 mg. Vomiting was induced 1 1/2 hour after ingestion in the out-patient clinic at the local hospital because of severe drowsiness. Due to continued lethargy he was transferred to the referral paediatric department for further observation. He was fully recovered after five to six hours without any treatment. Electrocardiographic monitoring was normal. Five incidents of cetirizine overdose in children have been reported previously. Drowsiness and sedation were observed, but no other side effects. The risk of cardiac events related to an overdose of cetirizine is extremely small. A certain degree of sedation is to be expected.     

Salinomycin poisoning in a Polish stud horse

24 cases of salinomycin poisoning in horses occurring recently in Silesia are discussed. All of these horses, used for riding-purposes, were fed with concentrate containing 61 mg/kg salinomycin as faulty prepared by the manufacturer. Each horse received approximately two to three kilograms of this forage. All horses developed severe clinical signs of intoxication. Despite therapy eight horses died within three to six days. Ten others became recumbent and had to be euthanased. Only six horses survived. Clinical and laboratory examinations were performed and are discussed. Laboratory examination of blood included red blood cell count, haematocrit, concentration of haemoglobin, enzyme activities of ASAT, ALAT and AP, also levels of urea, creatinine, sodium, potassium, magnesium, calcium and inorganic phosphor. Blood gas was also analysed. The dominating laboratory results were very high enzyme levels and alkalosis. The most characteristic clinical change appeared as paralysis of the hindlimbs.     

Occupational exposure to mercury in dentistry and dentist mortality

In response to public concern, Health Canada recently conducted a review of amalgam safety and released a position statement entitled The Safety of Dental Amalgam. Essentially, the department has concluded that the levels of mercury absorbed by the body due to the release of mercury vapor from amalgam restorations, while detectable, do not approach those recognized to cause illness. It has therefore confirmed that amalgam restorations can be used safely in most patients, with some notable caveats. Despite Health Canada's position statement in support of amalgam, patient doubts about amalgam safety remain, including the tenuous hypothesized link between amalgam restorations and specific diseases. This article reviews the available studies of dentist mortality to identify possible links between mercury exposure and negative health effects. A lack of evidence to suggest a detrimental health outcome in dentists who are occupationally exposed to higher levels of mercury than their patients, and are known to have higher levels of mercury in their blood, provides an important reassurance concerning the safety of amalgam. The reviewed data indicates that the 10 leading causes of death in the United States and Canada are the same for both dentist and non dentist population groups, and that the percentage of deaths by the same cause are remarkably similar. By 1975, the year of the most recent U.S. study, the average age at death for white male dentists was about three years higher than for all adult white males. Although suicide standard mortality rates are known to be higher for dentists, suicide deaths have also been shown to be a factor in many other occupations, particularly those where there is easy access to drugs. Although updated actuarial data for dentist mortality are needed, the available data indicate no reduction in the life expectancy of practising dentists, nor any specific or disproportionate rates of disease associated with high mercury exposure. In fact, the available mortality studies are generally optimistic about the health of dentists, which should reassure patients about the safety of dental amalgam.     

The dentist and preventive dental health information

Patients receive differing amounts of preventive dental health information from their dentist. What factors affect the amount of preventive information a patient receives? Many possible reasons which have been advanced for this difference are discussed in this paper. Using the clues presented in the literature, and results of a presurvey, some factors thought to influence the amount of preventive dental health information the patient receives were investigated. Specifically, the research problem was, "What is the relationship between the amount of preventive dental health information a patient receives from the dentist in his private office and the following factors: patient's appearance, interest-responsiveness, nervousness, need for dental care, request for service, orientation to dentistry, and dentist's liking for the patient?" The hypothesized relationships of amount of preventive dental information delivered to dentist's perception of patient's characteristics were not upheld. The paper tentatively concludes that the characteristics of the dentist and his dental practice affect the preventive information delivered more significantly than patient characteristics.     

Phenolphthalein poisoning: a case report

A case of severe poisoning due to the ingestion of phenolphthalein in the form of a patent medication, is described.     

Visiting the dentist: a behavioral community analysis of participation in a dental health screening and referral program

One-hundred and twenty-five families in the Medicaid Early Periodic Screening, Diagnosis and Treatment Program were assigned to one of five treatments to encourage parents to obtain health care service following the dental screening of their children: (a) a control procedure, in which parents were given a dentist's name; (b) a multiple contact procedure, in which parents received a postcard and two telephone call reminders; (c) a problem-solve procedure, in which a social worker aide conducted a brief session with the parent; (d) an incentive procedure, in which parents selected among four gifts that were contingent on seeking care; (e) an incentive + problem-solve procedure, in which the latter two treatments were combined. The multiple contact, incentive, and incentive + problem-solve techniques were significantly more effective in initiating dental visits than the control procedures. Families assigned to the intensive strategies were most likely to complete treatment. A cost-efficiency analysis showed the multiple contact technique to be a low-cost and highly effective procedure.     

Fatal sodium azide poisoning in a hospital: a preventable accident

A case of fatal sodium azide poisoning is reported. From the hospital staff, a 57 year old patient had obtained 1 g of sodium azide in order to put it as a preservative, in his 24 hour urinal. Probably due to an error, he swallowed the total dose. A cardiovascular collapse was cause of the death after five hours of intensive treatment and reanimation. Azide anions were found in blood (traces, less than 0.5 mg/L), vitreous (10 mg/L) and cerebrospinal fluid (20 mg/L). The use of sodium azide for disinfection of urine samples should be regarded as obsolete. Less toxic substances for disinfection are available. To avoid chemical disinfection, urine samples can be kept at 4-8 degrees C prior to rapid analysis.