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ABSTRACT: Trichloroisocyanuric acid is a high-efficiency and-low toxicity fungicide and bleach. It is commonly used as disinfectant for industrial circulating water, swimming pools, restaurants, and other public places in China. When trichloroisocyanuric acid is put into water, chlorine gas is produced. Chlorine gas is a potent pulmonary irritant that causes acute damage in both the upper and lower respiratory tracts (J Toxicol Clin Toxicol. 1998;36(1-2):87-93). Pneumomediastinum is a rare complication in patients with acute chlorine gas poisoning. A small amount of gas can be asymptomatic, but a large amount of gas entering the mediastinum suddenly will lead to respiratory and circulatory disorder, mediastinal swing, or even cardiopulmonary arrest. Severe chlorine gas poisoning patients usually need mechanical ventilation; if the pneumomediastinum is not found on time, threat to life would be greatly increased. It requires a high index of suspicion for diagnosis and rapid treatment. The proper use of ventilator, timely and effective treatment of original disease, and multiple system organ support had significant impact on the prognosis. The pneumomediastinum case secondary to inhalation of chlorine gas that we report here should remind all emergency department physicians to maintain a high index of suspicion for this disease and seek immediate and proper intervention when treating patients with acute chlorine gas poisoning, once diagnosed, especially in younger patients.
The American journal of emergency medicine 03/2011; 29(3):357.e1-4. · 1.54 Impact Factor
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ABSTRACT: OBJECTIVE To explore the changes of rat gastric mucosal barrier under conditions of water immersion restraint stress. METHODS Eighty rats were randomly divided into Group A (20 rats), B (40 rats) and C (20 rats) after being fasted for 24 hours. And then Group A was divided into two subgroups with ten rats in each. The two subgroups in Group A were given normal saline or omeprazole respectively while under the stress condition. The changes of gastric acid or bicarbonate secretion were determined. Group B (40 rats) were randomly divided into four subgroups,which were subgroup control, 1h, 2h and 4h after beginning of the stress. The quantity of glandular mucosal adherent mucus, the thickness of mucus gel layer and ulcer index were measured after stress in Group B. The glandular mucosal samples were labeled by Lanthanum and observed by transmission electromicroscopy. Group C was randomly divided into two subgroups in the same way with Group A. And each subgroup received normal saline or omeprazole respectively H(+) loss in gastric lumen was calculated by determining the difference of acidity between lavage and drainage fluid H(+) concentration. RESULTS It was found that gastric alkaline secretion decreased progressively (P < 0.05), while gastric acid secretion increased progressively under stress conditions (P < 0.05). The mucus quantity(A/g) in the four subgroups in Group B were 0.137 +/- 0.030, 0.143 +/- 0.012, 0.066 +/- 0.016 and 0.016 +/- 0.016 respectively. The mucus gel thickness(microm) were 71.08 +/- 5.85, 74.50 +/- 12.85, 57.63 +/- 6.45 and 51.35 +/- 2.84 respectively. The ulcer index were 0.2 +/- 0.1,0.4 +/- 0.1,5.2 +/- 1.3 and 10.0 +/- 0.5 respectively. Statistics showed that the mucus quantity was correlated with the mucus gel thickness positively(r = 0.89), while either of them was correlated with the ulcer index negatively(r = 0.85 and "r = 0.83). And it was also found that Lanthanum rarely stained the glandular mucosa in control subgroup, while heavily in stress subgroups. In the subgroup receiving normal saline in Group C, within 5 hours after the beginning of stress, the amount of H(+) loss per hour(micromol) was 2.03 +/- 0.12, 2.00 +/- 0.20, 1.93 +/- 0.49, 2.70 +/- 0.44 and 3.37 +/- 0.35 respectively. It was demonstrated that the amount of H(+) loss was stable within 2h after stress, then increased obviously in normal saline subgroup significantly (P < 0.01). In omeprazole subgroup, the amount of H(+) loss (micromol) was 7.46 +/- 1.22, 4.56 +/- 0.35, 3.11 +/- 0.81, 2.32 +/- 1.42 and 2.13 +/- 1.60, which decreased progressively, however still higher than those in normal saline subgroup (P "< 0.01). CONCLUSIONS The results suggest that gastric bicarbonate secretion is inhibited; gastric barrier is damaged; and hydrogen permeability through gastric mucosal barrier increases under stress conditions.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 06/2002; 41(6):374-7.
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ABSTRACT: To determine the expression of pS(2) (a member of trefoil peptides) in gastric mucosal of rats undergone WRS, and to probe the role of pS(2) in adaptive cytoprotection.
Wistar rats were exposed to single or repeated WRS for 4 h every other day for up to 6 days. Gastric mucosal blood flow (GMBF) was measured by LDF-3 Flowmeter. The degree of the gastric mucosal lesions (UI) was evaluated grossly and histologically. The expression of pS(2) was determined by RT-PCR and immunohistochemistry.
(1) WRS applied once produced numerous gastric mucosal erosions. UI gradually declined and GMBF restored on 3 d, 5 d after stress. UI was reduced to 20.8% and GMBF increased up to 94.5% of normal value. The expression of pS(2) was increased during the healing of stress-induced ulceration. The same results were observed by immunohistochemistry (0.50 +/- 0.13 vs 0.70 +/- 0.11, P < 0.01). (2) With repeated WRS, the adaptative cytoprotection against stress was developed. UI after four consecutive WRS was 22% of UI after one WRS. GMBF after four consecutive was 94.2% of normal value. Cell proliferation in the neck regions of gastric glands was activated. The expression of pS(2) was increased by using RT-PCR (0.37 +/- 0.02 vs 0.77 +/- 0.01, P < 0.01) and immunohistochemistry (0.55 +/- 0.04 vs 2.46 +/- 0.08, P < 0.01).
Increased expression of pS(2) could play an important role in adaptation of gastric mucose developed after repeated WRS.
Zhonghua yi xue za zhi 02/2002; 82(3):172-5.
