[Organophosphate poisoning in inexperienced workers].

Organophosphates are frequently used as insecticides in agricultural areas, therefore they may pose a risk for accidental exposure by dermal contact or through inhalation. We present the cases of eight young men, who worked unprotected and inexperienced with organophosphates. They were exposed dermally and developed mainly gastrointestinal symptoms and also diaphoresis, hypersalivation, blurred vision and miosis. One patient developed severe weakness, fasciculations, disorientation and sleepiness. All had low levels of plasma acetylcholinesterase. All were admitted to the hospital and received antidotal treatment of atropine and toxogonin. They were released after 48 hours in good physical condition. The hospital staff rapidly diagnosed the organophosphate intoxication; additional doctors and nurses were called to the emergency department. The patients were decontaminated in showers within the hospital. This case emphasizes the need for workers handling pesticides, to be supervised by an experienced person and the advantages of hospital drills in rapid diagnosis and preparedness to provide treatment to many patients.

Multidisciplinary team interaction: summary and Action Plan.

INTRODUCTION: Multidisciplinary team interaction has become a commonplace phrase in the discussion of disaster response. Theme 6 explored multidisciplinary team interactions and attempted to identify some of the key issues and possible solutions to the seemingly intractable problems inherent in this endeavour. METHODS: Details of the methods used are provided in the introductory paper. The Cochairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The Cochairs then presided over a workshop that resulted in the generation of a set of Action Plans that then were reported to the collective group of all delegates. RESULTS: Main points developed during the presentations and discussion included: (1) promotion of multidisciplinary collaboration, (2) standardization, (3) the Incident Command System, (4) professionalism, (5) regional disparities, and (6) psychosocial impact. DISCUSSION: Action plans recommended: (1) a standardized template for Needs Assessment be developed, implemented, and applied using collaboration with international organizations, focusing on needs and criteria appropriate to each type of event, and (2) team needs assessments be recognized for local responses and for determination of when international assistance may be required, for planning a command system, and for evaluating the psychosocial impact. CONCLUSIONS: There is a clear need for the development of standardized methods for the assessment of needs, development and implementation of a command structure, and for appreciation of regional differences and the psychosocial impact of all interventions.

[Trimethoprim-sulphamethoxazole-induced meningitis].

Drug-induced meningitis is rarely included in the differential diagnosis of aseptic (usually recurrent) meningitis. A 74-year-old man who suffered from recurrent aseptic meningitis following re-exposures to trimethoprim-sulphamethoxazole (Resprim) is presented. The clinical and laboratory findings resembled those found in bacterial meningitis, excluding normal glycorrachia. Extensive microbiological, serologic and imaging studies did not disclose any relevant findings. All symptoms and signs resolved rapidly following drug withdrawal, and findings on follow-up lumbar puncture were normal.

Life threatening hypophosphataemia in a patient with Philadelphia chromosome-positive chronic myelogenous leukaemia in acute blastic crisis.

Life-threatening hypophosphataemia developed in a 47 year old woman with blastic crisis of chronic myelogenous leukaemia. The patient's hospitalization was characterized by reciprocal relationship between her white cell count and the serum phosphorus levels. The patient did not demonstrate any of the usual causes of profound hypophosphataemia. The postulated mechanism of this patient's hypophosphataemia is uptake by the rapidly dividing leukaemic cells. To the best of our knowledge this is the first case in the English literature of hypophosphataemia associated with blast crisis of Philadelphia chromosome-positive chronic myelogenous leukaemia.