The epidemiology and characteristics of carbon monoxide poisoning among recreational boaters.

INTRODUCTION: Carbon monoxide (CO) poisoning has been reported in the setting of recreational boating however, previous research addressing the epidemiology of carbon monoxide-related injury and death in recreational boaters has been limited. MATERIALS AND METHODS: The United States Coast Guard (USCG) Recreational Boating Statistics annual reports for the 10-year period 2002 - 2011 were analyzed to determine the epidemiology and characteristics of carbon monoxide poisoning among recreational boaters in the United States. Regression analysis was performed to determine statistical significance for trend. RESULTS: The mean number of accidents, injuries and deaths per year due to CO exposure on recreational watercrafts was 14.5 (95% CI 12.1-16.9), 30.9 (95% CI 22.4-39.4) and 6.7 (95% CI 4.5-9.0) respectively. Cabin motorboats accounted for 49 accidents, 123 injuries and 29 deaths. California had 24 carbon monoxide- related accidents over the 10-year study period. Regression analysis showed no overall linear trend in the number of carbon monoxide-related boating accidents, injuries, or deaths as an absolute number or as a percent of all boating accidents, injuries or deaths over the study period. Discussion. The majority of carbon monoxide-related boating accidents, injuries and deaths occurred with cabin motorboats. The state with the largest number of carbon monoxide-related accidents over the 10-year study period was California. CONCLUSIONS: Carbon monoxide-related accidents involving recreational boating constitute an important and under recognized cause of injury and death in the United States.

Visión clínica del cáncer colorectal / Clinic approach of colo-rectal cancer

Se trata de una puesta al día del cáncer colorectal. Se hace hincapié en el avance de la genética que explica la progresión del adenoma al cáncer. Se analizan las lesiones premalignas y cómo encarar el diagnóstico temprano a partir del conocimiento de las mismas. Se pone énfasis en la prevención primaria a través de la identificación de la población de riesgo y en la prevención secundaria, de acuerdo a los factores de alto y bajo riesgo de la lesión inicial. Se revisa la importancia diagnóstica y el valor de los marcadores tumorales. Se presenta una síntesis del tratamiento y de la evaluación pre-operatoria que debe realizar el clínico

Plasma oxidase assay for screening of myocardial infarction.

The availability of techniques such as surgical reperfusion, angioplasty, and thrombolysis for the treatment of acute myocardial infarction (AMI) has revived interest in seeking an early detectable biochemical marker diagnostic for AMI. Therefore, we investigated whether an unidentified oxidase that is released by activated neutrophils at the onset of AMI could be used as an early diagnostic assay. The conversion by plasma oxidase of 1 microM of adrenaline to 1 microM of adrenochrome represents the plasma oxidase activity (POA) of 1 U/L. Fifty patients suspected of having AMI, 40% of whose electrocardiograms were nondiagnostic for AMI, were admitted to the coronary care unit, and venous blood samples were obtained for determination of the POA and creatine phosphokinase-MB levels. Healthy volunteers (n = 12) served as control subjects, and 8 patients with pneumonia whose leukocyte counts were greater than 15,000 microL were included in the study. In those with AMI (n = 22), as determined by serial creatine phosphokinase-MB, the mean POA (+/- standard error of the mean) was 233 +/- 13 U/L, and in those with angina and no AMI (n = 28) was 127 +/- 5 U/L (P < 0.0001). In the control group, mean POA (+/- standard error of the mean) was 84 +/- 5 U/L (control versus angina; P < 0.01) and for those with infection was 214 +/- 10 U/L. At admission, the creatine phosphokinase-MB was diagnostic for only 12 of the 22 patients with AMI (sensitivity rate of 54%), whereas in 21 of those patients, the POA values were diagnostic for AMI (sensitivity rate of 95%).(ABSTRACT TRUNCATED AT 250 WORDS)

Geographical pathology profile of AIDS in Puerto Rico: the first decade.

Postmortem histopathological changes in 100 adult patients with AIDS who died in Puerto Rico from 1982 to 1991 were studied and tabulated. Modes of HIV transmission were reviewed. Patient ages ranged from 21 to 60 yr. Gender composition for the patient group was 83 men (average age, 35 yr) and 17 women (average age, 39 yr). Sixty-eight of the patients were injecting-drug users, 20 were homosexual and bisexual men, seven were women who had had heterosexual contact with men at risk for HIV, and one was a man who had had heterosexual contact with prostitutes. Only one case was linked to transfusions of blood. Twenty-seven men and seven women were serologically tested for antibodies and all were HIV seroreactive. The most common causes of infection and the frequency of each were as follows: Pneumocystis carinii in 49 patients; cytomegalovirus in 43; Toxoplasma gondii in 30; Candida species in 24; Histoplasma capsulatum in 18; Mycobacterium species in 14; Cryptococcus species in eight; and Strongyloides stercoralis in six patients. Infection by Schistosoma mansoni (10 patients) was considered incidental because this trematode is endemic in Puerto Rico. The lung was the organ most frequently infected by a single microorganism: Pneumocystis carinii affected 49 patients. However, Cryptococcus species was the microorganism that infected more body systems: 20 different organs in eight patients. Nineteen patients had microglial nodular encephalitis, 86 patients had lymphocyte depletion in the spleen, and 58 had lymphocyte depletion in lymph node tissue. Twenty-seven men had testicular maturation arrest and variable germ cell loss. Three patients had malignant lymphoma, and two had Kaposi's sarcoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Amphotericin B overdose in pediatric patients with associated cardiac arrest.

OBJECTIVE: To report the first five cases of amphotericin B overdose with secondary cardiac complications in a pediatric population. Treatment is also presented. SETTING: Hospital. PATIENTS: Two infants and three children inpatients receiving amphotericin B. INTERVENTIONS AND RESULTS: Cardiac complications were observed in five pediatric patients who received between 4.6 and 40.8 mg/kg/d of amphotericin B. Cardiac arrest occurred in all patients, and four patients died. A detailed description of the cardiac event is provided for one patient who was on a cardiac monitor during the adverse reaction. Hydrocortisone prophylaxis and verapamil therapy were the primary therapies used in patient 1 (the only survivor). Evaluation of the literature provides substantial evidence for the use of hydrocortisone in prevention of cardiac arrhythmias. CONCLUSIONS: Amphotericin B overdose can be fatal in children and infants. The presentation in humans appears similar to that in dogs where cardiac arrhythmias occurred at doses of 5-15 mg/kg. Hydrocortisone may decrease the incidence of mortality associated with cardiac arrhythmias in children receiving amphotericin B overdoses. Animal studies are necessary to evaluate this observation and potential disadvantages of hydrocortisone usage.

Case report: lymphangitic carcinomatosis from cervical carcinoma--an unusual presentation of diffuse interstitial lung disease.

Pulmonary lymphangitic carcinomatosis is an unusual presentation of diffuse infiltrative lung disease. In this report, we present a case secondary to cervical carcinoma that has been previously reported in only four patients. The diagnosis was made by transbronchial lung biopsy.

Peritoneal blastomycosis.

Blastomycosis is a systemic fungal infection caused by Blastomyces dermatitidis. Involvement of the peritoneum is unusual, with only two previously reported cases that occurred in association with disseminated disease. A single case of histopathologically proven blastomycosis involving the peritoneum is presented, as well as a short overview of previously published cases on gastrointestinal and peritoneal blastomycosis. The case is unique in that chronic peritonitis was the only manifestation of disease. The diagnosis was made by laparoscopy.

[Osseous metastasis of an intracranial angioblastic meningioma: report of a case]. / Metástasis osea de un meningioma angioblástico intracraneal: informe de un caso.

A case of multiple bone metastases from an angioblastic meningioma (intracranial hemangiopericytoma) is reported. From the clinical and pathologic point of view, it is essential to be aware that the hemangiopericytic variant of meningioma (angioblastic meningioma) displays a significantly higher rate of recurrence and extracranial metastasis than other forms of meningioma.

Cicloxilic acid and the bile lipids in oral contraceptive users.

Cholesterol supersaturation of gallbladder bile induced by oral contraceptives is significantly reduced by the administration of cis-2-hydroxy-2-phenyl-cyclohexane-carboxilic acid (cicloxilic acid), a choleretic substance which has been demonstrated to exert an antilithogenic effect in the rat and in man.