Successful Management of Severe Exertional Heat Stroke with Endovascular Cooling After Failure of Standard Cooling Measures.

BACKGROUND: Exertional heat stroke (EHS) is a potentially life-threatening emergency requiring rapid reduction in core body temperature. Methods of cooling include cold water immersion, ice packs, cold water lavage, and chilled saline, among others. We report a case of EHS successfully cooled using an endovascular cooling device after traditional cooling methods failed to reduce core body temperature. CASE REPORT: A 24-year old soldier collapsed during a 12-mile foot march while training in southern Georgia. His initial rectal temperature was 43.1°C (109.6°F). External cooling measures (ice sheet application) were initiated on site and Emergency Medical Services were called to transport to the hospital. Paramedics obtained a repeat rectal temperature of 42.4°C (108.4°F). Ice sheet application and chilled saline infusion were continued throughout transport to the Emergency Department (ED). Total prehospital treatment time was 50 min. Upon ED arrival, the patient's rectal temperature was 41.2°C (106.2°F). He was intubated due to a Glasgow Coma Scale score of 4, and endovascular cooling was initiated. Less than 45 minutes later his core body temperature was 37.55°C (99.6°F). He was admitted to the intensive care unit, where his mental status rapidly improved. He was found to have rising liver enzymes, and there was concern for his developing disseminated intravascular coagulation, prompting transfer to a tertiary care center. He was subsequently discharged from the hospital 14 days after his initial injury without any persistent sequelae. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The primary treatment for EHS is rapid reduction of core body temperature. When external cooling methods fail, endovascular cooling can be used to rapidly decrease core body temperature.

Psychological functioning in African American women at an increased risk of hereditary breast and ovarian cancer.

Despite attention to psychological issues during genetic counselling and testing for hereditary breast and ovarian cancer risk, limited information is available on cancer-specific distress among African American women being targeted for participation in counselling and testing. Therefore, the purpose of this study is to examine cancer-specific distress in African American women at an increased risk of hereditary breast and ovarian cancer and to identify factors having significant associations with distress in this population. Respondents were 141 African American women identified for participation in genetic counselling and testing for BRCA1/2 mutations. Overall, respondents reported moderate levels of cancer-specific distress. Younger age (coefficient=6.0, p=0.001), being unemployed (coefficient=-5.0, p=0.01), and having a personal history of cancer (coefficient=5.0, p=0.02) had significant associations with intrusion. Younger age was also associated significantly with greater avoidance (r=6.0, p=0.02). These results suggest that African American women aged 50 and younger, those who are unemployed and women with a personal history of breast or ovarian cancer may be the most vulnerable to experiencing elevated levels of distress during genetic counselling and testing. Greater attention to psychological issues, including concerns about cancer and cancer risks, may be needed during genetic counselling and testing for BRCA1/2 mutations with these women.

Isolated splenic metastasis from colorectal carcinoma: report of a case and review of the literature.

In general, surgical resection for metastatic colorectal adenocarcinoma rarely benefits more than a small percentage of patients long term. In the case of isolated splenic metastasis without evidence of other metastatic disease, splenectomy may increase survival times in patients with previously resected colorectal adenocarcinoma. Currently there are only five case reports involving isolated splenic metastases in the English-language literature. This article presents a sixth case and a review of the previous five cases in the literature, with a discussion on the possible diagnostic and therapeutic approaches to these rare but important cases and the apparently significant survival advantage of early diagnosis and treatment.

Varying the message source in computer-tailored nutrition education.

The effect of message source on message recall and perceived credibility was examined in a randomized study comparing two different computer-tailored bulletins promoting fruit and vegetable consumption among rural African American church members. An expert oriented (EXP) bulletin was compared with a spiritual and pastor-oriented (SPIR) bulletin and a control group. Both bulletins had the same format and used an identical set of dietary and psychosocial variables for tailoring. At follow-up, the majority of both intervention groups recalled receiving the bulletin, however message trust was higher in the SPIR group (P < 0.05). The EXP group reported higher trust of health and nutrition information coming from scientific research (P < 0.01), and the SPIR group reported higher trust of information coming from the pastor (P < 0.05). Both bulletin groups increased fruit and vegetable consumption significantly compared to the control group; however, this difference could not be solely attributed to the tailored intervention which was part of a multi-component program.

Early introduction of solid foods among urban African-American participants in WIC.

OBJECTIVE: To compare infant feeding practices among low-income, urban, African-American women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) with current recommendations for infant feeding. DESIGN: Longitudinal follow-up of women and their infants who participated in a WIC-based breast-feeding promotion project. Women enrolled prenatally at or before 24 weeks of gestation were followed up until 16 weeks postpartum. SUBJECTS/SETTING: Two hundred seventeen African-American WIC participants in an urban area. METHODS: Data related to infant feeding practices were collected by interviewers who used a structured questionnaire to determine when nonmilk liquids or solids were introduced to the infant. Reported practices were compared with current recommendations. STATISTICAL ANALYSIS PERFORMED: Contingency table analysis, including chi 2 tests, and multivariate analysis using logistic regression. RESULTS: By 7 to 10 days postpartum, approximately a third of infants were receiving some nonmilk liquids or solids; this escalated to 77% by 8 weeks and 93% by 16 weeks postpartum. Women breast-feeding exclusively (i.e., not adding nonmilk liquids or solids) were least likely, and women providing mixed feeding (breast milk and formula) were more likely, than women feeding formula exclusively to introduce nonmilk liquids and solids at each data collection time period. APPLICATIONS/CONCLUSIONS: WIC participants who receive instruction about infant feeding nutrition are no more likely than mothers who do not participate in WIC to follow infant feeding guidelines recommended by the American Academy of Pediatrics in regard to the time when solids should be introduced to infants' diet. Our findings suggest the need for WIC to implement more powerful and innovative educational and motivational strategies to help mothers delay the introduction of nonmilk liquids and solid foods until their infants are 4 to 6 months old, as recommended.

WIC-based interventions to promote breastfeeding among African-American Women in Baltimore: effects on breastfeeding initiation and continuation.

We evaluated the single and combined effects of introducing a motivational video and peer counseling into four matched WIC clinics on breastfeeding initiation and continuation at 7-10 days among African-American WIC participants. Of the 242 women with complete data, 48% initiated breastfeeding, but only 31% were still breastfeeding at 7-10 days. Initiation was associated with cesarean delivery, infant feeding instruction, no artificial milk discharge pack, attending the peer counselor only-intervention site, and intention to breastfeed. Continuation was influenced by infant feeding instruction, no artificial milk discharge pack, and intention to breastfeed. Overall, trends toward a positive impact of the breastfeeding promotion activities were evident but weak, and largely gone by 7-10 days postpartum.

Tuberculosis in a day-care center, Kentucky, 1993.

In November, 1993, a 33-month-old child in a day-care center was diagnosed with tuberculosis (TB). To identify her source of infection, close contacts, other day-care children and staff were screened by tuberculin skin test (TST). TB registry and medical/laboratory records were reviewed. The only 2 community TB cases reported in the past 3 years were investigated. Of 164 children 2 were diagnosed with TB; their TSTs were > or = 10 mm but no specimens were obtained. Six children had TSTs > or = 5 mm. Of these 4 had TST conversions between December, 1993, and March, 1994. There were no additional positive TST children in June, 1994. No TB case was identified among staff or parents. A possible epidemiologic link with the index case was found for 1 community case. No source of infection was found for the other children. Possible explanations for not finding a source are: an as yet unidentified case in the day-care center or community; or false positive TST results in children related to low community prevalence of TB infection.

Computerized clinical dietetics management system.

A computerized Clinical Dietetics Management System (CDMS) was designed to support and facilitate accurate and timely delivery of clinical dietetics services. The CDMS is an integral part of a comprehensive hospital computer system that interfaces with 17 data bases. Thirty-one functions provide order processing, inquiry, calculations, message sending, charge capture, data base maintenance, and management reporting capabilities. System features include immediate and continuous access to the most current patient information, automatic routing of messages, a complete diet-order history for each patient and minimal printed output. Since implementation of the CDMS, users report benefits such as smoothing of workload peaks, fewer interruptions, fewer wasted trays, better and faster problem solving, and increased visibility in clinical dietetics services. The dynamic nature of the system allows additional applications to be added as they are developed.