5 results on '"COBALT TOXICITY"'
Search Results
2. Prosthetic Hip-Associated Cobalt Toxicity
- Author
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Andrew King, Anthony F. Pizon, Michael G. Abesamis, and Nathan B. Menke
- Subjects
inorganic chemicals ,medicine.medical_specialty ,Time Factors ,Arthroplasty, Replacement, Hip ,Health, Toxicology and Mutagenesis ,medicine.medical_treatment ,Total hip replacement ,chemistry.chemical_element ,Prosthesis Design ,Toxicology ,Risk Assessment ,COBALT TOXICITY ,Elevated serum ,Special Article ,Cobalt poisoning ,Predictive Value of Tests ,Risk Factors ,Metals, Heavy ,medicine ,Humans ,Diagnostic data ,Device Removal ,Chelating Agents ,business.industry ,Poisoning ,Cobalt ,medicine.disease ,Arthroplasty ,Chelation Therapy ,Surgery ,Heavy Metal Poisoning ,Treatment Outcome ,chemistry ,Toxicity ,Metal-on-Metal Joint Prostheses ,Hip Prosthesis ,business ,Biomarkers - Abstract
Prosthetic hip-associated cobalt toxicity (PHACT) is gaining recognition due to the use of metal-on-metal total hip replacements. Identifying true toxicity from merely elevated cobalt levels can be extremely difficult due to the lack of available data. An extensive review of the medical literature was undertaken to characterize cobalt toxicity from prosthetic hips. As an objective approach to making the diagnosis of PHACT, we suggest the following criteria: (1) elevated serum or whole blood cobalt levels due to a prosthetic hip, (2) at least two test-confirmed findings consistent with cobalt toxicity, and (3) exclusion of other etiologies. Adhering to objective diagnostic data for PHACT is a realistic and prudent method by which to eliminate the subjectivity of vague or difficult to identify complaints. These diagnostic criteria are not meant to evaluate prosthetic hardware failure, but as a means to identify systemic cobalt toxicity. Finally, assessment of cobalt toxicity from prosthetic hips should be done in conjunction with a medical toxicologist.
- Published
- 2013
3. Metal-on-Metal Hip Joint Prostheses: a Retrospective Case Series Investigating the Association of Systemic Toxicity with Serum Cobalt and Chromium Concentrations.
- Author
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Ho, James, Leikin, Jerrold, Dargan, Paul, Archer, John, Wood, David, and Brent, Jeffrey
- Subjects
ARTIFICIAL hip joints ,HEALTH outcome assessment ,DRUG toxicity ,SQUAMOUS cell carcinoma ,COMPUTED tomography ,COBALT ,THERAPEUTICS - Abstract
Introduction: There have been concerns about prosthesis failure and the potential for systemic toxicity due to release of cobalt and chromium from metal-on-metal hip joint prostheses (MoM-HP). There is conflicting evidence on whether there is a correlation between higher cobalt and chromium concentrations and systemic toxicity. Methods: We undertook a retrospective review of consecutive patients with MoM-HP referred for outpatient review in toxicology clinics in London, UK, and in the USA recorded in the Toxicology Investigators Consortium (ToxIC) Registry from June 2011 to June 2015. Results: Thirty-one cases were identified; the median (IQR) serum cobalt concentration was 10.0 (3.8-32.8) mcg/L, and the median (IQR) serum chromium concentration was 6.9 (3.7-18.7) mcg/L. Twenty-three (74.2%) had symptoms, most commonly lethargy, hearing loss, and tinnitus. The odds ratios of symptomatic/asymptomatic patients for metal ion concentrations above/below 7 mcg/L were 1.87 (95% CI 0.37-9.57, p = 0.45) and 0.60 (95% CI 0.10-3.50, p = 0.57) for cobalt and chromium, respectively. Two (6.5%) patients with systemic cobalt toxicity had median (IQR) serum cobalt concentrations significantly higher than those without systemic features (630.4 [397.6-863.2] mcg/L versus 9.8 [2.9-16.4] mcg/L; p = 0.017). However, overall, there were no differences between cobalt ( p = 0.38) or chromium ( p = 0.92) concentrations between symptomatic and asymptomatic patients and no clinical features or investigation results correlated with cobalt or chromium concentration. Conclusion: Two (6.5%) of 31 individuals referred for assessment of MoM-HP were diagnosed with systemic cobalt toxicity. However, despite a high prevalence of reported symptoms, neither symptoms nor investigation results correlated with serum cobalt or chromium concentrations. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
4. Metal-on-Metal Hip Joint Prostheses: a Retrospective Case Series Investigating the Association of Systemic Toxicity with Serum Cobalt and Chromium Concentrations
- Author
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David M. Wood, John R. H. Archer, James H. Ho, Jeffrey Brent, Paul I. Dargan, and Jerrold B. Leikin
- Subjects
Chromium ,Male ,inorganic chemicals ,medicine.medical_specialty ,Time Factors ,Arthroplasty, Replacement, Hip ,Health, Toxicology and Mutagenesis ,medicine.medical_treatment ,chemistry.chemical_element ,Toxicology ,Prosthesis ,Asymptomatic ,Gastroenterology ,03 medical and health sciences ,Lethargy ,0302 clinical medicine ,Risk Factors ,Internal medicine ,London ,Odds Ratio ,Prevalence ,medicine ,Humans ,Registries ,030212 general & internal medicine ,Aged ,Retrospective Studies ,030222 orthopedics ,business.industry ,Poisoning ,Retrospective cohort study ,Cobalt ,Odds ratio ,Middle Aged ,United States ,Prosthesis Failure ,Surgery ,Treatment Outcome ,chemistry ,Toxicity ,Metal-on-Metal Joint Prostheses ,Original Article ,Female ,Hip Prosthesis ,medicine.symptom ,business ,Biomarkers - Abstract
There have been concerns about prosthesis failure and the potential for systemic toxicity due to release of cobalt and chromium from metal-on-metal hip joint prostheses (MoM-HP). There is conflicting evidence on whether there is a correlation between higher cobalt and chromium concentrations and systemic toxicity. We undertook a retrospective review of consecutive patients with MoM-HP referred for outpatient review in toxicology clinics in London, UK, and in the USA recorded in the Toxicology Investigators Consortium (ToxIC) Registry from June 2011 to June 2015. Thirty-one cases were identified; the median (IQR) serum cobalt concentration was 10.0 (3.8–32.8) mcg/L, and the median (IQR) serum chromium concentration was 6.9 (3.7–18.7) mcg/L. Twenty-three (74.2%) had symptoms, most commonly lethargy, hearing loss, and tinnitus. The odds ratios of symptomatic/asymptomatic patients for metal ion concentrations above/below 7 mcg/L were 1.87 (95% CI 0.37–9.57, p = 0.45) and 0.60 (95% CI 0.10–3.50, p = 0.57) for cobalt and chromium, respectively. Two (6.5%) patients with systemic cobalt toxicity had median (IQR) serum cobalt concentrations significantly higher than those without systemic features (630.4 [397.6–863.2] mcg/L versus 9.8 [2.9–16.4] mcg/L; p = 0.017). However, overall, there were no differences between cobalt (p = 0.38) or chromium (p = 0.92) concentrations between symptomatic and asymptomatic patients and no clinical features or investigation results correlated with cobalt or chromium concentration. Two (6.5%) of 31 individuals referred for assessment of MoM-HP were diagnosed with systemic cobalt toxicity. However, despite a high prevalence of reported symptoms, neither symptoms nor investigation results correlated with serum cobalt or chromium concentrations.
- Published
- 2017
5. The Role of Chelation in the Treatment of Other Metal Poisonings.
- Author
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Smith, Silas W.
- Subjects
CHELATION ,METAL toxicology ,ALUMINUM ,DEFEROXAMINE ,ETHYLENEDIAMINETETRAACETIC acid ,COBALT ,URANIUM ,RADIOISOTOPES ,ACETYLCYSTEINE - Abstract
These proceedings will review the role of chelation in five metals—aluminum, cadmium, chromium, cobalt, and uranium—in order to illustrate various chelation concepts. The process of “chelation” can often be oversimplified, leading to incorrect assumptions and risking patient harm. For chelation to be effective, two critical assumptions must be fulfilled: the presumed “metal toxicity” must correlate with a given body or a particular compartment burden, and reducing this compartmental or the body burden (through chelation) attenuates toxicity. Fulfilling these assumptions requires an established dose–response relationship, a validated, reproducible means of toxicity assessment (clinical, biochemical, or radiographical), and an appropriate assessment mechanisms of body or compartment burden. While a metal might “technically” be capable of chelation (and readily demonstrable in urine or feces), this is an insufficient endpoint. Clinical relevance must be affirmed. Deferoxamine is an accepted chelator for appropriately documented aluminum toxicity. There is a very minimal treatment window in order to address chelation in cadmium toxicity. In acute toxicity, while no definitive chelation benefit is described, succimer (DMSA), diethylenetriaminepentaacetate (DTPA), and potentially ethylenediaminetetraacetic acid (EDTA) have been considered. In chronic toxicity, chelation is unsupported. There is little evidence to suggest that currently available chromium chelators are efficacious. Similarly, scant human evidence exists with which to provide recommendation for cobalt chelation. DTPA has been recommended for cobalt radionuclide chelation, although DMSA, EDTA, and N-acetylcysteine have also been suggested. DTPA is unsupported for uranium chelation. Sodium bicarbonate is currently recommended, although animal evidence is conflicting. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
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