硫黄入浴剤服用による中毒症例を経験した。57歳女性。入浴剤六一〇パップを約200mL服用し, 約1時間後に救急搬送された。来院時, 意識レベルはJCS-II-30・せん妄状態で著明なチアノーゼ, 過換気と代謝性アシドーシスを認めた。胃洗浄施行後, 精神科病棟に入院させた。その後呼吸不全, ショックとなり, ICUに収容した。人工呼吸下に再度胃洗浄行い, 活性炭投与, 強制利尿等を施行した。硫化水素 (HS) 中毒に対する特異療法としてニトログリセン持続静脈内を投与開始したが, 来院17時間後に死亡した。は広く市販されているが, 服用時の毒性については知られていない。今後市民への啓発等の対応を要すると考えられる。

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A 62-year-old man suffered poisoning from 30ml of calcium polysulfide‘610-happu^®’, which was sold as a common bath agent, agricultural product, and fungicide. Though a fatal dose of calcium polysulfide is reported to be 50-150ml, he developed cardiopulmonary arrest (CPA) 10 minutes after the intake of“610-happu”and survived with aggressive supportive therapy. Calcium polysulfide reacts with stomach acid and generates hydrogen sulfide. Hydrogen sulfide poisoning was thought to have caused the CPA. After resuscitation, disseminated intravascular coagulation was developed. On the 6th day after admission to the ICU, serum amylase elevated. Abdominal CT revealed a small amount of ascites and no signs of pancreatitis. On Day 19, we detected pancreatic pseudocyst formation. It was suspected that gastric mucosal burn had developed a perforation of the posterior wall, followed by pancreatitis. Both respiratory arrest by hydrogen sulfide and corrosive chemical injury of the stomach due to a small amount of calcium polysulfide poisoning were observed.

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　硫化水素は自然界に広く存在する毒性ガスで、腐乱臭を呈し空気よりやや重い。火山帯や温泉で発生する他にも、下水道、ゴミ処理場、石油精製工場などでも発生する。硫化水素は人体に対して吸入濃度により様々な症状を発現する。チトクロムオキシダーゼ阻害の作用だけではなく神経毒としての作用があり、高濃度の硫化水素を吸入すると中枢神経系へ素早く移行する。特に呼吸中枢を含む、脳幹に選択的に取り込まれ、1000ppm以上を吸入した場合、意識消失、呼吸停止を来たし死亡する。
　硫化水素中毒の原因は、自然災害、労働災害、自殺に分けることができる。自然災害の典型的な被害は温泉地や火山帯での事故である。火山地帯で無風、曇りなどの天候と窪地の条件により硫化水素が高濃度になり、立ち入った観光客などが被害に遭っている。温泉では2014年に北海道足寄温泉での硫化水素事故以来、環境省では入浴施設での規制を行っている。しかし、源泉では依然として高濃度の硫化水素の中で勤務が行われ、温泉管理者に対しての対策が取られていない。
　労働災害ではマンホールでの硫化水素の事故が年間数例発生している。現場では高い硫化水素濃度だけではなく低酸素環境のため、死亡者が発生する。このような環境で作業する場合には酸素濃度18%以上、硫化水素濃度が10ppm以下であることが求められている。
　自殺については、日本国内で2008年に硫化水素自殺が頻発した。警察庁の発表では2008年1月から11月での自殺者は1007名になったとされている。これは硫化剤の（または石灰硫黄合剤）と酸性洗剤のサンポールを混ぜて発生させている。日本では下火になったものの、この硫化水素自殺は海外に波及し、アメリカやイギリスでも同様の事例が頻発している。

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Scabies has become a common disease, not sexually transmitted but transmitted in households. Although it is also known to cause an epidemic in hospitals for the aged patients or residential homes, no effective treatment was taken for it at the present time.
From January 1985 to December 1992, 424 patients with scabies (249 males and 175 females) visited the Dermatological clinic of Nippon Medical School Main Hospital. In these cases, only 13 patients (3.1%) were recognized as having STD. The sources of infestation were unclear in most cases where the disease was transmitted in households, which account for 38.5% of the patients. In 68 cases (16.0%), outbreaks of scabies in hospitals and residential homes affected the patients as well as the staffs and their families. The number of scabies cases which were infested in hospitals is increasing yearly. It is speculated that the hospitals for the aged patients and residential homes are becoming the main source of scabietic infestation.
Only 16.6% of the patients were previously diagnosed or suspected to have scabies by their family doctors. It seems that the diagnosis of scabies is extremely difficult for the general practitioner. A considerable number of the patients who had been diagnosed or suspected to have scabies changed their doctor or stop visting them. This is because an appropriate treatment is not available in most of medical facilities.
At the time of the first visit to our clinic, 93.6% of the patients was diagnosed or suspected to have scabies, and the mite was demonstrated in 63.2% of the patients. It is suggested that careful inspection of scabietic burrows and the skillful technique to demonstrate the mite are essential to establish the diagnosis of scabies.
Atopic dermatitis was the most common diagnosis of the patients who were misdiagnosed at the first time and later turned out to have scabies. These patients did have atopic dermatitis besides scabies.
After the treatment with benzyl benzoate with crotamiton, 70.3% of the patients were cured and up to 94.9% of the patients were over improved. We compared the therapeutic effect of phenothrin to that of benzyl benzoate. Benzyl benzoate had more antipruritic effect and a little more improvement of skin lesion than phenothrin. However, there was no significant difference between benzyl benzoate and phenothrin in the period of time until the skin lesion cleared. Phenothrin is considered to have an adequate therapeutic effect for scabies.

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