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1.
Artigo em Inglês | MEDLINE | ID: mdl-38833354

RESUMO

ABSTRACT: Vape juice is a diluent for e-cigarette active ingredients, nicotine or tetrahydrocannabinol (THC). Lack of strict regulation in vape juice production is a concern as ingredients and their concentrations may vary widely from the labeling.A 43-year-old woman was transported via ambulance to the hospital after ingesting homemade vape juice, presenting unresponsive with decerebrate posturing. She reportedly made a tincture combining a vape juice purchased online (containing "ethylene glycol") and THC for "endometriosis-related pain relief." Laboratory evaluation revealed anion gap metabolic acidosis, elevated serum lactate, and high serum osmolality. Urine fluoresced under Wood's lamp, and fomepizole was administered as an ethylene glycol antidote, but she expired the following afternoon. Clinical serum toxicology results returned after death revealed 235 mg/dL of methanol, and no ethylene glycol.Autopsy findings included ischemic changes of the gastrointestinal tract and cerebral edema with herniation. Postmortem toxicology performed on hospital admission blood revealed methanol (220 mg/dL), propylene glycol (59 mg/dL), Δ-9 THC and metabolites, and medications administered during hospitalization. The medical examiner determined the cause of death to be methanol and propylene glycol toxicity.To our knowledge, this is the first report of accidental death from ingestion of vape juice contaminated with toxic alcohol.

2.
Lancet ; 396(10247): 320-332, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32682491

RESUMO

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of an ongoing pandemic, with increasing deaths worldwide. To date, documentation of the histopathological features in fatal cases of the disease caused by SARS-CoV-2 (COVID-19) has been scarce due to sparse autopsy performance and incomplete organ sampling. We aimed to provide a clinicopathological report of severe COVID-19 cases by documenting histopathological changes and evidence of SARS-CoV-2 tissue tropism. METHODS: In this case series, patients with a positive antemortem or post-mortem SARS-CoV-2 result were considered eligible for enrolment. Post-mortem examinations were done on 14 people who died with COVID-19 at the King County Medical Examiner's Office (Seattle, WA, USA) and Snohomish County Medical Examiner's Office (Everett, WA, USA) in negative-pressure isolation suites during February and March, 2020. Clinical and laboratory data were reviewed. Tissue examination was done by light microscopy, immunohistochemistry, electron microscopy, and quantitative RT-PCR. FINDINGS: The median age of our cohort was 73·5 years (range 42-84; IQR 67·5-77·25). All patients had clinically significant comorbidities, the most common being hypertension, chronic kidney disease, obstructive sleep apnoea, and metabolic disease including diabetes and obesity. The major pulmonary finding was diffuse alveolar damage in the acute or organising phases, with five patients showing focal pulmonary microthrombi. Coronavirus-like particles were detected in the respiratory system, kidney, and gastrointestinal tract. Lymphocytic myocarditis was observed in one patient with viral RNA detected in the tissue. INTERPRETATION: The primary pathology observed in our cohort was diffuse alveolar damage, with virus located in the pneumocytes and tracheal epithelium. Microthrombi, where observed, were scarce and endotheliitis was not identified. Although other non-pulmonary organs showed susceptibility to infection, their contribution to the pathogenesis of SARS-CoV-2 infection requires further examination. FUNDING: None.


Assuntos
Infecções por Coronavirus/patologia , Pneumonia Viral/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Células Epiteliais Alveolares/patologia , Células Epiteliais Alveolares/ultraestrutura , Células Epiteliais Alveolares/virologia , Autopsia , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Feminino , Trato Gastrointestinal/patologia , Trato Gastrointestinal/ultraestrutura , Trato Gastrointestinal/virologia , Coração/virologia , Humanos , Rim/patologia , Rim/ultraestrutura , Rim/virologia , Fígado/patologia , Fígado/ultraestrutura , Fígado/virologia , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Miocárdio/ultraestrutura , Pandemias , Pneumonia Viral/epidemiologia , Alvéolos Pulmonares/patologia , Alvéolos Pulmonares/ultraestrutura , Mucosa Respiratória/patologia , Mucosa Respiratória/ultraestrutura , Mucosa Respiratória/virologia , SARS-CoV-2 , Baço/patologia , Baço/ultraestrutura , Baço/virologia , Trombose/patologia , Traqueia/patologia , Traqueia/ultraestrutura , Traqueia/virologia , Washington/epidemiologia
3.
Clin Anat ; 27(2): 210-21, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23959836

RESUMO

The trend towards regional anesthesia began in the late 1800s when William Halsted and Richard Hall experimented with cocaine as a local anesthetic for upper and lower limb procedures. Regional anesthesia of the upper limb can be achieved by blocking the brachial plexus at varying stages along the course of the trunks, divisions, cords and terminal branches. The four most common techniques used in the clinical setting are the interscalene block, the supraclavicular block, the infraclavicular block, and the axillary block. Each approach has its own unique set of advantages and indications for use. The supraclavicular block is most effective for anesthesia of the mid-humerus and below. Infraclavicular blocks are useful for procedures requiring continuous anesthesia. Axillary blocks provide effective anesthesia distal to the elbow, and interscalene blocks are best suited for the shoulder and proximal upper limb. The two most common methods for localizing the appropriate nerves for brachial plexus blocks are nerve stimulation and ultrasound guidance. Recent literature on brachial plexus blocks has largely focused on these two techniques to determine which method has greater efficacy. Ultrasound guidance has allowed the operator to visualize the needle position within the musculature and has proven especially useful in patients with anatomical variations. The aim of this study is to provide a review of the literature on the different approaches to brachial plexus blocks, including the indications, techniques, and relevant anatomical variations associated with the nerves involved.


Assuntos
Anestesia por Condução/métodos , Plexo Braquial/anatomia & histologia , Plexo Braquial/diagnóstico por imagem , Humanos , Bloqueio Nervoso/métodos , Ombro/anatomia & histologia , Ombro/diagnóstico por imagem , Ombro/inervação , Ultrassonografia , Extremidade Superior/anatomia & histologia , Extremidade Superior/diagnóstico por imagem , Extremidade Superior/inervação
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