Fatal myocarditis and pulmonary oedema following scorpion sting: Report of two cases

Presentation of two cases of scorpion sting with myocarditis and pulmonary oedema and a description of currently accepted pathophysiology and management of the cardiovascular manifestations of scorpion envenomation. Case report. Departments of medical cardiothoracic and medicine, King Fahd Central hospital, Gizan, Kingdom of Saudi Arabia. Two cases of scorpion envenomation. Two boys aged 13 and 14 years were stung by the yellow scorpion [Leiurus quinquestriatus]. They presented to hospital late, with features of myocarditis, pulmonary oedema and a shock-like syndrome. The ECGs showed arrhythmias and an acute myocardial infarction pattern. Polyvalent scorpion antivenom was administered and intensive supportive treatment given but, they died during hospitalization. Envenomation by the yellow scorpion Leiurus quinquestriatus causes cardiovascular manifestations which may prove fatal if treatment is not prompt and appropriate. A knowledge of the pathophysiology of scorpion envenomation is essential for the proper management of its cardiovascular complications

Valvular heart disease in end-stage renal failure patients on maintenance hemodialysis.

To determine the presence of, and factors associated with, valvular heart disease in end-stage renal failure patients by M-mode, two-dimensional and Doppler echocardiography. Case series of an unselected group of patients on maintenance haemodialysis. Haemodialysis unit and echocardiography laboratory of the King Fahd Central Hospital, Gizan, Saudi Arabia Sixty patients on haemodialysis for at least 6 months. Main outcome measures: Detection of functional and structural valve abnormalities and their relation to putative aetiological factors. The mean age was 34.4 [SD13.0], range 14-66 years; 31 [51.7%] were men and 29 women. The duratior of dialysis was 37 [SD 29] months with a range of 6-106 months. Mitral regurgitation was found in 20 [33.3%], mitral annular calcification in 3 [5.0%], aortic valve calcification in 5 [8.3%] and tricuspid regurgitation in 8 [13.3%] patients At least one of these lesions was present in 22 [36.7%] patients. No patient had mitral or aortic stenosis. There were significant associations found between left ventricular mass and mitral regurgitation; calcium-phosphate product and aortic valvular calcification; and right ventricular enlargement and tricuspid regurgitation. Mitral and tricuspid regurgitation were common in our dialysis patients. The calcium and phosphate product was found to be an important determinant of aortic valvular calcification. Further studies are needed to determine whether early control of calcium and phosphate levels would prevent the development of this complication

Acquired benign tracheooesophageal fistula of infectious origin

An acquired tracheooesophageal fistula in a 25 - year old male Yemeni patient was shown to be a complication of a disseminated fungal infection. He did not have any evidence of immunodeficiency. The patient was treated with amphotericin B combined with surgical closure of the fistula, with a favourable outcome. Clinicians are reminded that among the causes of acquired tracheooesophageal fistulae they must consider fungal infections which can be rewardingly treated