Treatment of accidental digital injection of epinephrine.

The use of epinephrine auto-injectors for prehospital treatment of severe allergic reactions has become increasingly popular in recent years. Anxiety when patients are called on to use these spring-loaded devices may lead to complications. We present the case of a 28-year-old woman who accidentally injected epinephrine 1:1,000 solution 0.3 mL into her right index finger with an automatic epinephrine injector. The approach to the treatment of these complications has been varied in the literature, including local sympathectomy, topical nitrates, and either local or intra-arterial phentolamine. This potentially disabling case of epinephrine-induced vasospasm of digital arteries was treated successfully with local infiltration of phentolamine.

Sigmoid mesenteric tumour as a manifestation of von Recklinghausen's disease.

The gastrointestinal tract may be involved in up to 25% of cases of von Recklinghausen's disease. The authors report such a case in which an 18-year-old girl presented with gastrointestinal symptoms secondary to a tumour in the sigmoid mesentery. There was no family history so it was presumed to be a case of spontaneous mutation. The authors discuss the protein manifestations of neurofibromatosis emphasizing the gastrointestinal presentations and the need for careful surgical management.

Legionnaires' disease: clinical features of the epidemic in Philadelphia.

A review of the medical records of 123 persons with Legionnaires' disease hospitalized in the 1976 Philadelphia epidemic showed that the manifestations of infection ranged from mild grippe to a severe pneumonia that also involved other organ systems. Early in the illness, constitutional symptoms predominated. Fever, malaise, myalgia, rigors, confusion, headache, and diarrhea were usually followed by nonproductive cough and dyspnea. Physical examination showed few abnormalities other than rales. Moderate leukocytosis with left shift, elevated erythrocyte sedimentation rate, elevation of serum levels of liver enzymes, and hematuria and proteinuria were characteristic. Chest radiograph showed patchy, often nodular, areas of consolidation. Progression of pneumonia led to respiratory failure and the need for mechanical ventilatory assistance for 19 patients; renal failure, primarily after shock, occurred in 18 persons. Twenty-six patients died. Treatment with erythromycin or tetracycline resulted in the lowest case-fatality ratios, but the associations were not statistically significant.

Effects of hypercapnia and inspiratory flow-resistive loading on respiratory activity in chronic airways obstruction.

The respiratory responses to hypercapnia alone and to hypercapnia and flow-resistive loading during inspiration were studied in normal individuals and in eucapnic and hypercapnic patients with chronic airways obstruction. Responses were assessed in terms of minute ventilation and occlusion pressure (mouth pressure during airway occlusion 100 ms after the onset of inspiration). Ventilatory responses to CO2 (deltaV/deltaPCO2) were distinctly subnormal in both groups of patients with airways obstruction. The two groups of patients, however, showed different occlusion pressure responses to CO2 (deltaP100/deltaPCO2): deltaP100/deltaPCO2 was normal in the eucapnic patients but subnormal in the hypercapnic patients. Flow-resistive loading during inspiration reduced deltaV/deltaPCO2 both in normal subjects and in patients with airways obstruction. The occlusion pressure response to CO2 increased in normal subjects during flow-resistive loading but remained unchanged in both groups of patients with chronic airways obstruction. These results indicate that while chemosensitivity as determined by deltaP100/deltaPCO2 is impaired only in hypercapnic patients with chronic airways obstruction, an acute increase in flow resistance elicits a subnormal increase in respiratory efferent activity in both eucapnic and hypercapnic patients.