Auto-aggressive metallic mercury injection around the knee joint: a case report

<p>Abstract</p> <p>Background</p> <p>Accidental or intentional subcutaneous and/or intramuscular injection of metallic mercury is an uncommon form of poisoning. Although it does not carry the same risk as mercury vapour inhalation, it may cause destructive early and late reactions.</p> <p>Case Presentation</p> <p>Herein we present the case of a 29-year-old male patient who developed an obsessive-compulsive disorder causing auto-aggressive behaviour with injection of elemental mercury and several other foreign bodies into the soft tissues around the left knee about 15 years before initial presentation. For clinical examination X-rays and a CT-scan of the affected area were performed. Furthermore, blood was taken to determine the mercury concentration in the blood, which showed a concentration 17-fold higher than recommended. As a consequence, the mercury depots and several foreign bodies were resected marginally.</p> <p>Conclusion</p> <p>Blood levels of mercury will decrease rapidly following surgery, especially in combination with chelating therapy. In case of subcutaneous and intramuscular injection of metallic mercury we recommend marginal or wide excision of all contaminated tissue to prevent migration of mercury and chronic inflammation. Nevertheless, prolonged clinical and biochemical monitoring should be performed for several years to screen for chronic intoxication.</p

Tracing data journeys through medical case reports: Conceptualizing case reports not as 'anecdotes' but productive epistemic constructs, or why zebras can be useful

Medical case reports provide an important example of data journeying: they are used to collect data and make them available for re-use to others in the field including clinicians, biomedical researchers, and health policymakers. In this paper, I explore how data journey in case reports, with particular focus on the earliest stages of the process, namely from creation and publication of case reports to the initial re-uses of them and data within them. I investigate key themes relating to case reporting and re-use, including factors which seem to smooth the path along which the data captured by a case report journey via broader citation patterns and detailed qualitative analysis of highly re-used case reports. This analysis reveals some of the key factors associated with the case reports whose data have greater amounts of journeying including publication in a general medical journal; that the data have broader implications and evidential value for topical or even urgent issues for instance in public health; and use in the case report of multiple research methods or concepts from diverse subfields. These findings along with standardization of case reporting are shown to have epistemological implications, particularly for how we understand the journeying of data.Rachel A. Anken