ABSTRACT
The response of the abdominal viscera and the contraction of the intercostal muscles during the respiratory phase of sneezing increases intrathoracic pressure, which may lead to several complications. However, there are no reports in the literature concerning aortic dissection after sneezing. We report a patient in whom the development of dissection was secondary to sneezing, although hypertension was present as a risk factor, and we discuss the relationship between sneezing and aortic dissection. To our knowledge, this is the first report of aortic dissection provoked by sneezing in the literature.
Subject(s)
Aortic Aneurysm, Thoracic/etiology , Aortic Dissection/etiology , Sneezing , Acute Disease , Aortic Dissection/diagnostic imaging , Aortic Aneurysm, Thoracic/diagnostic imaging , Humans , Hypertension/complications , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Our aims were to investigate the frequency of intracranial lesions detected by cranial computed tomography (CT-scan) amongst adult patients who had clinical warning criteria (CWC) for secondary neurological headaches and to determine the importance of CWC in predicting a possible lesion on CT-scan. Seventy consecutive patients with headache exhibiting CWC were included in this prospective study. The CWC included: (i) increase in the intensity and frequency of headache; (ii) abrupt onset of headache; (iii) persistence of headache despite analgesics; (iv) alteration of the characteristics of headache; and (v) presence of focal neurological symptoms or findings. The mean age of the patients was 46.5 years; the female-to-male ratio was 1.5. Of the patients, 35.7% had a neurological cause identified by CT-scan, and 64.3% had normal CT-scan. In the patients without lesion, of headaches, 64.4% were primary, and 35.6% were from undefined headache group. Although, of the above criteria, only the 5th was different markedly in the patients with lesion than the patients without lesion, in evaluation by CT-scan the secondary neurological headaches in adults, all CWC should look for absolutely in their history and physical examination.
Subject(s)
Brain Diseases/complications , Headache/diagnosis , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Analgesics , Brain Diseases/diagnosis , Diagnosis, Differential , Disease Outbreaks , Disease Progression , Drug Tolerance , Female , Headache/etiology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neurologic Examination , Prospective Studies , Recurrence , Risk Factors , Time FactorsABSTRACT
Amitraz, a formamidine insecticide and acaricide used in veterinary practice, presents side effects in humans related to its pharmacological activity on alpha 2-adrenergic receptors. There is little information available in the literature about the toxicology of the product in man and the treatment of this poisoning. In this report, the clinical and laboratory features of amitraz poisoning in two patients by a veterinary formulation also containing xylene are presented. The major clinical findings were unconsciousness, drowsiness, respiratory failure requiring mechanical ventilation, miosis, hypothermia and bradycardia. The laboratory findings were hyperglycemia, hypertransaminasemia and increased urinary output. Supportive management of this poisoning in humans is suggested in only a few articles and there is no specific antidote for the subsequent possible pharmacological effects of amitraz. In our two cases, we performed supportive treatment such as mechanical ventilation, atropine, gastric lavage, active carbon, oxygen and fluid administration. We concluded that the basic approach to the patient with amitraz poisoning, including initial stabilization to correct immediate life-threatening problems, treatment to reduce absorption and measures to improve elimination of the toxin, is effective.
