Laser treatment of imipramine-induced hyperpigmentation.

BACKGROUND: Blue or slate-gray hyperpigmentation is seen with a variety of medications, including imipramine. We describe a patient with significant imipramine-induced pigmentation. OBJECTIVE: The purpose of this study was to describe an effective laser treatment resulting in improvement of imipramine-induced hyperpigmentation, without discontinuing the medication. METHODS: The patient underwent treatment with carbon dioxide, erbium, alexandrite, and ruby lasers to hyperpigmented areas. Tissue biopsy specimens taken before treatment, immediately after treatment with the alexandrite laser, and at clearing were analyzed by light microscopy. RESULTS: The Q-switched alexandrite and ruby lasers resulted in clinical improvement in the patient's hyperpigmentation and a decrease in pigment granules on light microscopy. CONCLUSION: Both the Q-switched alexandrite and ruby lasers are effective treatments for imipramine-induced hyperpigmentation. The improvement is progressive with successive sessions.

Use of a dynamic method in calibration of dye-dilution curves during cardiac surgery.

A simplified dynamic method of calibration for dye-dilution curves is described. The method involves appropriate matching of the fluid volume in the mixing chamber, the blood withdrawal rate, and the calibration dose of dye. It was used to compare the observed versus calibrated pump output of a heart-lung machine with individual dye-dilution curves obtained from 15 patients during total cardiopulmonary bypass. The results indicate that the difference (range+14% to-8%) between the two is statistically insignificant. The method is rapid and relatively simple. It is particularly useful for cardiac output determination during unsteady clinical conditions because of the ability to calibrate dye curves at the time they are recorded.

Electrocution in the operating room.

PIP: The manner in which a patient sustained an electrical shock injury from improperly wired equipment during the course of an operation was described in order to acquaint others with a potentially hazardous situation. A patient requiring surgical treatment had the ground plate of an electrocautery unit placed under her buttocks and the electrodes of an EKG unit attached to her shoulders and her precordium. During the course of the operation, the EKG monitor was subject to electrical interference. In an effort to correct the problem, the surgeon instructed the nurse to unplug the monitor and reinsert the plug into a 2nd wall receptable. As the plug was reinserted, the physician suffered a minor shock and the patient experienced an intense shock. She became cyanotic and her pulse stopped. The patient was revived and later recovered completely. Inspection of the equipment revealed that the EKG's power plug was incorrectly wired. The chassis ground was connected to the neutral plug instead of the ground plug. Furthermore, the 2nd wall receptacle was wired with reversed polarity. When the plug was inserted into the 2nd receptacle, a 110 volt alternating current developed between the precoidal EKG lead and the ground plate. If the monitor had been plugged into the 2nd receptacle prior to the operation, the monitor would not have functioned. The technician probably would have assumed that the machine was not in working order and would have substitued another machine. In order to minimize electrical shocks, EKG leads should be applied only to the extremities and not to the precordium region.^ieng