Anticholinesterase Therapy for Patients with Ophthalmoplegia Following Snake Bites: Report of Two Cases

Although ophthalmoplegia following snake bites is not indicative of a serious neurotoxic complication, symptoms of diplopia, dizziness and ocular discomfort can be emotionally devastating for patients. The authors experienced two cases of ophthalmoplegia following snake bites in Korea. The patients complained of diplopia that had developed several hours after the snake bites. The diplopia did not improve with antivenom treatment, but resolved completely after several injections of neostigmine.

A Study of Elder Neglect in the Emergency Department

PURPOSE: The first visit to the emergency department of patients subjected to elder abuse should influence the direction of treatment in both the inpatient and the outpatient departments and thus the outcome. We tried to find risk factors of elder abuse by using information from families of death-on-arrival patients over age of 60 years and by evaluating the situation of the actual condition of elder abuse. METHODS: From January 2003 to August 2003, we prospectively interviewed 93 families of patients over 60 years of age who visited the emergency center of Korea University Hospital and who were dead on arrival. We classified them into three groups: neglected, actively neglected and nonneglected. Risk factors analyzed were age, sex, alcohol abuse, cerebrovascular accident, and depression. We examined time during which families left their elderly to die without visiting a physician after noticing abnormal signs. RESULTS: Thirty-nine (39) cases (41.94%) were classified as neglected and 13 (13.98%) cases as actively neglected. Statistically meaningful risk factors were age, alcohol abuse, and cerebrovascular accident in the actively neglected groups. There was no meaningful risk factor in the neglected group. The time during which families left their parents to die without medical decision was 35+/-12.0 days in the neglected group, 35+/-19.0 days in the actively neglected group, and 4+/-1.1 days in non-neglected group. Among those left to die without a visiting physician, 25 cases were in neglected group (56.8%), and 9 cases (20.5%) were in the actively neglected group. CONCLUSION: Emergency physicians can make a great contribution to the treatment of elder abuse by recognizing the risk factors, connecting the patients with prevention centers, and maintaining long-term outpatient follow up after the first visit to the emergency department.

Lack of IL-10 Release from Human Polymorphonuclear Leukocytes

PURPOSE: Polymorphonuclear leukocytes (PMNs) are the first line of cellular response for host defense during acute inflammation. The ability of PMNs to produce and release numerous pro-inflammatory cytokines is now estabilished and plays an important role in triggering and maintaining the inflammatory response. We studied the autocrine downregulation of this process by invesgating the potential production by human PMNs of the major anti-inflammatory cytokine, interleukine 10 (IL-10). METHODS: Human PMNs were isolated from the peripheral blood of health volunteers by using the modified boyum method. Human PMNs were incubated at 37 degrees Cwith and without formyl Met-Leu-Phe (fMLP) for 30 minute, 2 hours, 4 hours, and 20 hours. The level of IL-10 was determined in each of the cell-free supernatants by using the enzyme linked immunosorbent assay (ELISA) method. RESULTS: Non-stimulated PMNs generated 1.40 +/- 1.791pg/mL to 3.46 +/- 1.607 pg/mL of IL-10 over the time course. Stimulation with fMLP resulted in an increase in the constitutive PMN-derived IL-10 by 2.74 +/- 0.762 pg/mL, 1.27 +/- 0.262 pg/mL, 1.19 +/- 0.364 pg/mL, and 2.44 +/- 1.317 pg/mL at 30 min, 2 hr, 4 hr, and 20 hr after stimulation, respectively, but these increases were not statiscally significant. CONCLUSION: Human PMNs seem unable to induce release of the most potent anti-inflammatory cytokine, IL-10, and down-regulate inflammatory response due to the autocrine mechanism. This could partly account for the persistence of local inflammation, when PMNs are the main infiltrating cells.