Clinical toxicology
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The authors have observed 59 cases of bismuth encephalopathy between 1972 and 1979. Eight female patients in this group showed osteoarticular lesions confined exclusively to the thoracic vertebrae and the humerus. ⋯ Intraspongy microfractures due to the intense and repeated myoclonia could explain osteonecrosis. It has been suggested that bismuth facilitates the modification of the bony tissue; however, the evidence remains inconclusive as there are few anomalies of phosphocalcic metabolism.