Inadvertent intrathecal use of ionic contrast media for myelography.

PURPOSE: To describe instances of inadvertent intrathecal injection of ionic contrast media and to consider treatment approaches, and diagnostic and medicolegal issues. METHODS: Ten cases of inadvertent injection, of which nine were reported to the manufacturers/authors and one appeared in the literature, are related with emphasis on similarity of reactions. RESULTS: Six criteria are enumerated and used to coin the term "ascending tonic-clonic seizure syndrome." CONCLUSIONS: Therapeutic possibilities seem limited, but several methods for controlling seizures are suggested. The importance of identifying the contrast material is underscored. Awareness of the grave possibility of administering the wrong contrast material is the first step in avoiding this problem; awareness of the symptoms is the first step toward therapy.

Use of benzodiazepines in primary-care geriatric patients.

From a sample of 257 elderly patients, 93 subjects who had received benzodiazepine (mainly diazepam) prescriptions for one or more years were interviewed about their subjective perception of the drug's effects and their attitudes regarding its use. The subjects were predominantly women: mean age was 72 years. All subjects had begun use of benzodiazepine more than two years earlier, although some had since stopped using the drug; more than a third had used it for more than six years. About half of the subjects said they took no more of the drug than had been initially prescribed, and three quarters reported they took the medications only when a need was felt. The principal indication for use of benzodiazepines was described as tension. Those who were still taking the drug at the time of interview were more likely to live alone and to say that they had the same problems as when they began its use. None of the subjects who had discontinued use of the drugs had been aware of withdrawal symptoms, and there was no evidence that any subject had become addicted, although several expressed a fear of this. It appears that in this age group, prolonged use of benzodiazepine at low doses, with the patients regulating the quantity, is safe and may be helpful. Most subjects, even if not helped, always kept some of the drug at home in case they might need it.

Bicycle-related accidents and injuries in a population of urban cyclists.

To gain a better understanding of urban bicycle-related accidents and injuries, 93 Manhattan cyclists were asked to fill out a questionnaire on the subject and the results of their responses were analyzed. They reported a total of 51 bicycle-related accidents and 59 injuries of varying degrees of severity. Although 42 percent declared they used safety helmets, head trauma was reported by 25 percent of the injured cyclists. Most were not wearing protective headgear at the time of their injury, however. Increased cycling mileage and length of time cycling were significantly associated with increased accident occurrence. Surprisingly, 47 percent of the accident victims cited themselves as being at fault for the accident in which they were injured.