Botulinum toxin A and neuropathic pain: An update.

Botulinum toxin type A is a widely used neurotoxin for the treatment of muscle hyperactivity such as dystonia and spasticity. Several clinical trials have also reported an efficacy of subcutaneous or intradermal administrations of botulinum toxin A on various neuropathic pain conditions including idiopathic trigeminal neuralgia and found that specific sensory phenotypes were predictors of the response. This narrative review summarizes the potential mechanisms of action, efficacy and safety of botulinum toxin A in neuropathic pain as well as its place in the therapeutic algorithm of neuropathic pain.

Impact of alcohol consumption on winter sports-related injuries.

INTRODUCTION: This study was carried out to evaluate data about trauma-related winter sports, including risk factors such as high speed, gender, age, alcohol consumption, details about the accident and snow conditions. METHODS: A retrospective review was conducted to determine the injury patterns and crash circumstances in holiday skiers and snowboarders. The data recorded were obtained from the database of the Pre-Hospital Emergency Registry of six skiing areas in the Dolomite mountains during the winter seasons November 2004-May 2009, injury data for major traumas from Ski Patrol Injury reports (helicopter, ambulance or ski slopes' patrol reports), and intrahospital Emergency Department data. Alcohol concentration in blood was detected in 200 individuals suffering from major trauma. RESULTS: A total of 4550 injured patients, predominantly male (69%), mean age 22 years (range 16-72), were included in the observational analysis. Knee, wrist and shoulder injuries were frequently associated with major thoracic, abdominal or head traumas (64% of cases). Suboptimal technical level, high speed, low concentration, snow or weather conditions, faulty equipment and protective devices were among the various causes of accidents. The analysis revealed that high alcohol blood concentration was present in 43% of 200 patients. CONCLUSIONS: Even though the major causes of accidents were excessive speed, excessive fatigue, technical errors and bad weather conditions, alcohol abuse was often discovered. Random sampling and a non-systematic detection of alcohol blood levels likely led to an underestimation of alcohol consumption-related injuries. It is recommended that investigations into alcoholic intoxication in injured skiers should be carried out on a large scale.

Helicopter rescue and prehospital care for drowning children: two summer season case studies.

BACKGROUND: Drowning is the second leading cause of unintentional injury-related death in children <14 years of age and is one of the most important causes of accidental injury between the ages of 1 and 4 years. In this study, the characteristics of non-fatal unintentional drownings in a small series of pediatric victims were examined. METHODS: We retrospectively analyzed data collected by the rescue team from May to October in two consecutive years (2006, 2007). RESULTS: Nine accidents occurred in public waters, while 5 occurred in lakes and rivers. The submersion time reported ranged from approximately 5 to 15 min. The ground emergency service with basic life support rescue experts intervened within a mean of 12 min. Advanced cardiac life support maneuvers were implemented by the helicopter medical crew for all victims. Ten of the 14 children remained in cardiocirculatory arrest despite cardiopulmonary resuscitation (CPR). The Glasgow Coma Scale (GCS) was <8 in all cases. Field resuscitation ultimately proved successful for every child. Thus, none was transported by the helicopter with ongoing CPR. All submersion-injured children survived. No postanoxic cerebral injury or major neurological complications were detected. CONCLUSION: Assuring safe tracheal ventilation, achieving intravenous access, and stabilizing both respiratory and hemodynamic disturbances on the ground before transferring the patient are the keys to out-of-hospital management. Our 100% survival rate likely results from adequate primary out of-hospital care. Promptly dispatching a helicopter with a specialized medical crew is very expensive, but is worth the cost because it offers a better chance of survival.

Demand and availability of Intensive Care beds. A study based on the data collected at the SUEM 118 Central of Padua from October 1996 to December 2001.

AIM: This study aims to evaluate the management of intensive care beds according to the demands received by the SUEM 118 of Padua. It has been carried out by examining the reports drawn up by SUEM physicians from October 1996 to December 2001. The study rated the number of patients for whom an admission to the Intensive Care Unit (ICU) was required, according to the specific clinical situation at the moment of the request. A secondary objective was to evaluate if the critically ill patients had been admitted and treated in the most appropriate medical facility. METHODS: The research is based on 7 087 reports concerning a population of adult and pediatric patients for whom an ICU bed was required in the period previously mentioned. For each report, it analyses the following data (keeping them anonymous): date of demand, main pathology and severity of clinical condition, sex and age, provenence and destination. RESULTS: Even though the number of annual demands for an ICU bed made to SUEM Central 118 has remained unchanged (approximately 1 350 per year), the number of beds made available in the operating rooms of the Hospital of Padua markedly increased. What has been experienced so far, and the data collected in this study has revealed, was that the requests for an intensive treatment for the overall population (hospitalized and non hospitalized) increased disproportionally in relation to the availability of ICU beds. In fact, the total number of hospitalizations in the different ICUs rose steadily year by year (from 3 495 in 1996 to 4 640 in 2001). CONCLUSION: The Hospital of Padua is a landmark center for patients who need specialized treatment. It is therefore important to increase the assistance and safety standards of its ICUs. In recent years there has been a great need for specialized ICUs either for more aggressive procedures (neurosurgical, cardiosurgical, respiratory, cardiologic, etc.) or for the increased use of adequate and invasive treatment for advanced diseases. The available resources of ICU beds should be more rationally distributed between the peripheral and the Regional Hospitals, since the activation of an ICU bed in the operating theatre is a valid, transient option.