Toluene induced hypokalaemia: case report and literature review.

Generalised weakness is a common complaint. A case is presented of toluene induced hypokalaemia in a 22 year old woman who presented with generalised weakness. The effect of toluene and causes of weakness and hypokalaemia in this setting are discussed.

Delayed antivenom treatment for a patient after envenomation by Crotalus atrox.

Bites by the Western diamondback rattlesnake (Crotalus atrox) are the most common cause of envenomation in Texas. We describe a patient who had delayed administration of antivenom after envenomation by C atrox. Because of an initial adverse response to a test dose, the patient had been unwilling to receive antivenom therapy. When compartment syndrome developed 52 hours after envenomation, however, the patient consented to antivenom therapy as an alternative to fasciotomy. We documented a decrease in compartment pressures and resolution of thrombocytopenia that was concomitant with antivenom administration.

A retrospective analysis of 96 "asp" (Megalopyge opercularis) envenomations in Central Texas during 1996.

BACKGROUND: The most frequently reported caterpillar envenomation in Central Texas is by the puss caterpillar or "asp," Megalopyge opercularis. This caterpillar is described by patients and physicians as inflicting intense radiating pain. The intensity of symptoms may be underestimated leading to undertreatment. Adequate treatment protocols have been lacking and those in use are not very successful. We present a retrospective study of patients who were stung and contacted the Central Texas Poison Center. METHODS: All human exposures to asp stings reported to the Central Texas Poison Center during 1996 were included. Inclusion criteria consisted of all cases documented as an asp envenomation by the specialists in poison information. Characterization of symptoms and treatment used were evaluated. RESULTS: There were 96 exposures to asps reported. Ninety-five of the patients experienced local pain with 26 of these reporting intense radiating pain. Forty developed erythema, 27 described edema, and 9 complained of welts/hives. Other symptoms reported included white spots (4), pruritus (3), red streak (2), numbness (2), and individual accounts of chest pain, rash, ecchymosis, tingling, blister, and muscle spasm. There was no treatment modality that promptly relieved pain. DISCUSSION: Although asp envenomations appear to be very common, clinical cases have rarely been documented. This may be due to physicians not recognizing the etiological agent. Pain may be very intense and standard pain management appears to be unsuccessful. CONCLUSION: This study suggests that further examination of treatment modalities may be beneficial in addressing the morbidity of Megalopyge opercularis envenomations.

Dietary effect on urinary thioethers.

Urinary thioethers are a biomarker for reactive metabolites, which are detoxified via glutathione. We conducted this study to establish the effect of diet on a sample of persons we screened to exclude exposure from such substances. Our second objective was to develop a distribution curve to be used for comparison to exposed populations. Volunteers were sought who did not work or live in locations where known toxic exposures were likely to occur. We mainly recruited office personnel and secretarial staff. We screened subjects for environmental exposures via a written questionnaire. Subjects gave us an initial random urine specimen before they were placed on a diet low in thioethers. We then measured urinary thioethers on these specimens with a modified Ellman technique. We compared 126 paired results. Results demonstrated that diet decreased urine thioether excretion in most cases (i.e., 75 of 126 had a decrease in thioethers). Initially, the difference in mean excretion at the time of prediet and postdiet, however, was not significant (p = .22). We removed 2 extreme outliers, the result of which was a significant difference in means (paired t test, p < .01). The standard deviation within each of the two groups did not differ significantly (p = .82).

Comparison of two new immobilization collars.

STUDY OBJECTIVE: To evaluate the limitation of movement of four cervical collars, with emphasis on two new extrication collars. DESIGN: Ranges of motion permitted by four extrication collars, measured by two goniometric techniques, were compared. Times required to apply each collar were noted and compared. SETTING: In a laboratory setting, volunteers were asked to flex, extend, laterally bend, and rotate their necks, first without restriction and then with each of the collars applied. TYPE OF PARTICIPANTS: Participants were healthy volunteers who worked either in the Department of Physical Therapy or in the Emergency Department of Tulane Medical Center Hospital. INTERVENTIONS: The collars used were the Nec-Loc Extrication Collar, Philadelphia Collar, Philadelphia Red EM Collar with Immobilizer, and Vacuum Splint Cervical Collar. MEASUREMENTS: Measurements were performed first using the head goniometer and then the hand-held goniometer. Time required for application was measured in seconds. Statistical evaluation was performed using repeated measure analysis of variance and then Newman-Keuls multiple comparison procedure. MAIN RESULTS: The Vacuum Splint Cervical Collar restricted range of motion of the cervical spine most effectively. CONCLUSION: A cervical collar with design characteristics similar to the Vacuum Splint Cervical Collar (ie, a rigid collar that incorporates part of the thorax) will restrict movement of the neck more effectively than shorter, less rigid collars.

Clinical experience with immediate breast reconstruction using tissue expansion or transverse rectus abdominis musculocutaneous flaps.

We retrospectively reviewed our experience with immediate breast reconstruction in 103 consecutive patients with stage 0 or I breast carcinoma between May 1983 and April 1988. Two reconstructive techniques were used, that is, either tissue expansion with secondary prosthesis implantation (60%) or transverse rectus abdominis musculocutaneous (TRAM) flap (40%). Chemotherapy was administered in 22% of patients without delay or compromise. The mean length of follow-up is 30 months. The complication rate was equal for both groups (24%) with infection being most common in the group of patients with tissue expansion and partial flap necrosis being most common in the group of patients with TRAM flaps. Aesthetic results were superior with use of the TRAM flap. Our experience concurs with previous reports that documented satisfactory results with immediate breast reconstruction without compromising further therapy. We conclude that although the tissue expansion technique yields acceptable results, the TRAM flap yields superior aesthetic results in terms of both appearance and consistency.

Fluphenazine decanoate: a clinical problem?

The authors compared the medical records of 20 randomly selected schizophrenic patients who were receiving fluphenazine decanoate with the records of 20 other randomly selected schizophrenic patients who were receiving oral medications only. The fluphenazine decanoate group had a significantly higher mean chlorpromazine equivalent dose (2010 +/- 836) than the oral medication group (373 +/- 384). The two groups did not, however, differ on any of the other variables studied. The findings, in addition to reports in the literature, suggest that the use of fluphenazine decanoate may come at the inadvertent cost of a significantly higher dose of antipsychotic medications in a subgroup of patients.

Augmentation mammaplasty by cadaver fat allografts.

Two Soviet women were treated for complications of breast hardening and tenderness following augmentation mammaplasty using cadaver fat allografts. The cadaver fat grafts were excised and replaced with silicone-gel prostheses in the submammary pockets. The implants were found to contain necrotic fat tissue with areas of fibrosis and calcification; however, no signs of rejection were evident. Both patients had a successful postoperative outcome.

Reduction mentoplasty.

A reduction in the projection of the chin can balance a profile, particularly following a rhinoplasty. It is important, however, that dental and facial bone relationships first be assessed in order to rule out the existence of complicating conditions. This examination may or may not include radiologic studies or dental models. The surgery can be performed under local anesthesia. A minimum of 2.5 to 3.0 mm of bone must be resected in order to effect change.