[The first case of rabies in Sweden in 26 years. Inform travellers abroad about risks and treatment following suspected infection]. / Första rabiesfallet i Sverige på 26 år. Informera utlandsresenärer om risker och behandling efter misstänkt smitta.

In June 2000, a case of rabies was diagnosed in Stockholm. The patient, a 19-year-old woman, had been bitten by a dog in Thailand three months earlier. She was admitted with a 2-day history of pain and paresthesia at the exposure site (right arm), along with anxiety. Her neurological symptoms progressed, and during the following week she developed the typical signs of furious rabies. Despite intensive care, her condition deteriorated continuously, and she died 18 days after onset of symptoms. The diagnosis was not considered until five days after admission to the hospital. A saliva sample was obtained and the diagnosis confirmed by virus isolation in mouse neuroblastoma cells. Although Sweden is free of rabies, the diagnosis should be considered in patients with encephalitis after having visited a rabies endemic area. Tourists must be informed of the vital importance of post-exposure prophylaxis after suspected infection.

A placebo-controlled experimental study of steroid inhalation therapy in ammonia-induced lung injury.

BACKGROUND: The use of corticosteroids in toxic lung injury caused by exposure to an irritating gas such as ammonia has not been adequately studied. OBJECTIVE: To evaluate the effects of budesonide inhalation in a rabbit model of toxic lung injury induced by ammonia. DESIGN: Randomized, blind placebo-controlled laboratory investigation employing 16 New Zealand White rabbits. Lung injury was induced by inhalation of a defined amount of aerosolized ammonia. Thirty minutes later, the rabbits were randomized to receive either inhalation therapy with 0.5 mg budesonide or placebo. After another 2 hours, a second treatment inhalation, identical to the first one, was administered. RESULTS: Airway pressures, hemodynamics, and gas exchange were measured at baseline, 5, and 15 minutes after ammonia administration and every 30 minutes during a 6-hour period after the first blind inhalation of corticosteroids or placebo. The ammonia inhalation resulted in an acute severe lung injury, detected after 15 minutes as a decrease in Pao2 from 23.3 (+/- 3.6) to 11.0 (+/- 3.6) kPa (p < 0.005) and an increase in peak airway pressure from 13 (+/- 2) to 17 (+/- 2) cm H2O (p < 0.005). During the 6-hour observation period, the blood gas parameters improved gradually in all rabbits. In comparison with placebo, budesonide did not result in improved gas exchange or reduced airway pressure levels during the observation period. CONCLUSION: In this animal model corticosteroid inhalation therapy had no effect on ammonia-induced lung injury.

Fatal hyponatraemic brain oedema due to common gastroenteritis with accidental water intoxication.

Acute symptomatic hyponatraemia is a life-threatening emergency which must be diagnosed and treated promptly. The initial symptoms are often dramatic, with seizures and coma, and there is therefore a risk that the diagnosis and the urgent sodium correction therapy may be delayed by procedures such as computed tomography (CT) of the brain. As the most common aetiological factors are psychotic polydipsia and different iatrogenic causes, this condition usually develops in hospitalised patients. Water intoxication alone is very unlikely to cause severe hyponatraemia in a person with normal renal function, unless for some reason the antidiuretic hormone secretion is increased. We describe a case in which dehydration due to common gastroenteritis in combination with excessive intake of water caused the death of a young, previously healthy woman. Increased awareness of this potentially fatal condition is recommended.