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A 25-year-old man fell with his right lower limb into a pool of 40% hexavalent chromium at room temperature. At first, he showed no symptoms, but one hour later he felt itching along his right leg and went to a nearby hospital, where his left leg was washed with water. He was then referred to our hospital for further treatment. On the first day of hospitalization, only brownish areas of discoloration were noted around the inside of the right thigh and lower leg. In spite of our systemic treatment with N-acetylcystein and dimercaprol and local treatment with 10% ascorbic acid, the patient developed deep dermal chemical burns and those area increased from 1% to 5% . On the 12th day of hospitalization, skin transplantation was performed and the postoperative course was satisfactory. Even though injury to the skin caused by hexavalent chromium may seem minor at first, medical staff should be watchful with regard to such chemical burns since they can take a sudden turn for the worse.

We examined the usefulness of Magnetic Resonance Imaging (MRI) test in the acute phase of carbon monoxide intoxication for forecasting delayed encephalopathy (DE). [Case 1] 26-year-old female. COHb 12%. Takotsubo (Ampulla) cardiomyopathy was supervened. Pallidal disorder was recognized in MRI test in the early stage. Although Prophylactic HBO was performed, DE began. 36 days later, disorder was recognized in large area, such as, in cerebral white matter and callosum, and abnormality was found in WMS-R and MMSE. Since HBO was performed, DE subsided. In MRI test, on the other hand, high signal range in cerebral white matter and callosum were gradually decreased and WMS-R and MMSE were improved. [Case 2] 19-year-old female. COHb 9.4%. The state was considered to be mild but pallidal disorder was found in MRI test at the beginning. DE did not start, then the part of pallidal disorder was narrowed. WMS-R and MMSE showed slightly low level. [Case 3] 19-year-old female. COHb 7.3%. The state was considered to be mild and there was no abnormal findings in MRI test in the early stage. DE did not start. [Case 4] 48-year-old male. COHb 48.9%. Rhabdomylosis was supervened, then ischemic change in a left radiate crown was recognized in the early MRI test. Since the third day, disorientation and restlessness had been developed, so that the patient was transferred to psychiatric department, though it was still difficult to distinguish the case from DE. Although the case is relatively mild, pallidal disorder is recognized in the early MRI test. Pallidal disorder alone can cause memory disorder and cognitive impairment. Even if pallidal disorder alone is recognized in the early MRI test, white matter disorder is developed with time, and then DE begins. If there are no typical carbon monoxide intoxication findings, some cases can be suspected as DE. It is useful to perform serial MRI test in order to prepare for delayed encephalopathy in carbon monoxide intoxication.

A case of fatal chloropicrine poisoning induced by suicidal ingestion was reported. The patient was found unconsciousness in his room with drinking about 100 ml of chloropicrine sodium at 8:55 in the morning and brought to a nearby hospital. He was transported to our ER at 10:17. 7 hours after ingestion, he died from metabolic acidosis and acute cardiac failure. It was difficult to detect chloropicrine in his serum and gastric content with GC/MS method. At the present, we must be severe to store and use chloropicrine as there is no specific treatment of chloropicrine poisoning. It is necessary to protect from exposure to volatile agricultural chemicals such as chloropicrine for prevention of secondary disaster.