Paravertebral compartment syndrome after exercise: a case report.

BACKGROUND: Paravertebral compartment syndrome occurring without trauma is quite rare. We report a case of compartment syndrome that occurred after spinal exercises. CASE PRESENTATION: A 23-year-old Japanese rower developed severe back pain and was unable to move 1 day after performing exercises for the spinal muscles. Initial evaluation at a nearby hospital revealed hematuria and elevated creatine phosphokinase levels. He was transferred to our hospital, where magnetic resonance imaging revealed no hematoma but confirmed edema in the paravertebral muscles. The compartment pressure measurements were elevated bilaterally. Despite his pain being severe, his creatine phosphokinase levels were expected to peak and decline; his urine output was normal; and surgery was undesirable. Therefore, we opted for conservative management. The next day, the patient's compartment pressure diminished, and his pain levels decreased to 2/10. After 5 days, he was able to walk without medication. CONCLUSIONS: We present a rare case of compartment syndrome of the paravertebral muscles with good resolution following conservative management. We hope our case findings will help avoid unnecessary surgery in cases of paravertebral compartment syndrome.

[Clinical analysis of 104 cases of overdose in suicide attempts].

Patients who have attempted suicide by taking medicines are frequently admitted to emergency and critical care medical centers. These patients usually have both physical and mental problems. Some try repeatedly to commit suicide. In this study, to ascertain how to prevent repeated attempts of suicide, we investigated the clinical characteristics of patients attempting suicide by taking overdoses of medicine. One hundred and four cases of suicide attempted by taking an overdose of medicine, seen at The Emergency and Critical Care Medical Center, Tottori University Hospital, Tottori from April 2005 to March 2006, were investigated in this retrospective study. Patients were 25 males (24%), and 79 females (76%). Eighty one patients (77.9%) had regularly been receiving psychiatric care, with neurotic disorders being the most common psychiatric condition. Thirty eight patients (36.5%) had repeated suicide attempts by taking an overdose of medicine. In 2005, there were 9 patients (9.4%) who had repeatedly consulted our critical care medical center. Most of these patients were females who had previously consulted a psychiatric clinic and had diagnoses of stress-related or personality disorders. In this study, we demonstrated that it is important to build a good relationship between psychiatrists and emergency doctors. As well, to prevent repeated incidents of taking an overdose of medicines in a suicide attempt, it is important to ensure that medical and psychosocial support are positively applied to patients with such tendencies.

[Case of tetrodotoxin intoxication in a uremic patient].

Ingestion of certain types of puffer fish can result in severe and potentially lethal intoxication, referred to as tetrodotoxin (TTX) intoxication. It is well known that respiratory support plays a key role in the management of patients with TTX intoxication. We describe here the case of a 52-year-old uremic woman, who complained of numbness of the lips and weakness in the legs after ingestion of puffer fish (Lagocephalus wheeleri; called shirosaba-fugu in Japanese). While her symptoms were not severe and she did not require respiratory support, her condition did not improve after 2 days of hospitalization. Hemodialysis was therefore performed on hospital days 3, 4 and 5, and resulted in marked improvement of symptoms. We suggest that the patient's renal dysfunction caused an accumulation of TTX due to delayed excretion and thus modified the clinical course of TTX intoxication. Hemodialysis may be effective in the treatment of TTX intoxication. This is the first report of TTX intoxication in a uremic patient in Japan, and, importantly, the first report of intoxication with Lagocephalus wheeleri, which was previously considered to be a non-toxic species.