Manganese deposition in the brain following parenteral manganese administration in association with radical operation for esophageal cancer: report of a case.
We report herein the case of a patient in whom manganese (Mn) deposition in the basal ganglia was detected by magnetic resonance imaging (MRI) subsequent to thoracic esophagectomy, performed following perioperative parenteral nutrition. A multi-trace-element supplement solution which included 20 micromol of Mn per day had been parenterally administered for 7 days preoperatively and 21 days postoperatively. The serum level of total bilirubin reached a maximum value of 5.1 mg/dl postoperatively. The T1-weighted MRI on the 32nd postoperative day demonstrated bilateral and symmetrical hyperintense lesions in the globus pallidus and the whole-blood Mn level on the 34th postoperative day was 4.9 microg/l, the normal range being 0.8-2.5 microg/l. This hyperintensity on T1-weighted MRI was gradually improved following normalization of the blood Mn level. This case report serves to demonstrate that even short-term perioperative parenteral nutrition may result in Mn deposition in the brain following radical surgery for esophageal cancer, especially in patients with hyperbilirubinemia.
Kondoh
H
H
Department of Surgery, Rinku General Medical Center, Izumisano Municipal Hospital, Rinku-Orai-Kita, Izumisano, Osaka, Japan.
Iwase
K
K
Higaki
J
J
Tanaka
Y
Y
Yoshikawa
M
M
Hori
S
S
Osuga
K
K
Kamiike
W
W
D000368:Aged; D001479:Basal Ganglia / Q000378:metabolism*; D004938:Esophageal Neoplasms / Q000601:surgery*; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008345:Manganese / Q000032:analysis / Q000378:metabolism*; D010289:Parenteral Nutrition, Total
D008345:Manganese