Military medicine
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Chronic exertional compartment syndrome (CECS) can be a debilitating condition observed in athletes, including military service members. Surgical fascial release, first described in 1956, has long been a standard treatment despite symptom recurrence in up to 45% of surgically treated military service members. A 2013 case series introduced intracompartmental Botulinum Toxin-A (BoNT-A) injections as a nonsurgical CECS treatment option, demonstrating efficacy for 15 of 16 patients. ⋯ Military service member treated with ultrasound-guided BoNT-A for bilateral lower leg CECS. This patient achieved pain-free activities for 36 months with one treatment. This case, coupled with additional literature, supports consideration of BoNT-A as a potential long-term, nonsurgical alternative for CECS.
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The differential diagnosis of vesiculobullous lesions can be intimidating to the primary care provider. While some entities such as bullous impetigo may easily be diagnosed clinically if the patient's demographics as well as the lesion morphology and distribution present classically, atypical presentations may require additional laboratory studies for confirmation. We describe a case of bullous impetigo with characteristics that clinically mimicked two rare immunobullous dermatoses. Although extensive diagnostic testing was performed, we recommend an approach for primary care providers to initiate empiric treatment while maintaining awareness of less common immunobullous entities.
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Historical Article
Chemical Warfare in Ancient Greek Ionia: Mass Intoxication With Hecate's Deleterium.
The rich land of Erythrae in the coast of Asia Minor attracted the attention of the Ionian king Codrus. An oracle demanded the presence of the murky deity Hecate for him to conquer the city. Priestess Chrysame was sent by Thessalians to set the strategy of the clash. ⋯ The beast was captured and sacrificed. In the feast that followed, all ate a piece of his flesh and went crazy, stimulated by the poison, an easy prey for the army of Codrus. The deleterium used by Chrysame is unknown, but her strategy shaped the origin of biowarfare.
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Case Reports
Transient Proximal Median Nerve Entrapment in a Tetraplegic Hand Cyclist Following a 24-Hour Endurance Race.
Median nerve entrapment is a frequent disorder encountered by all clinicians at some point of their career. Affecting the distal median nerve, entrapment occurs most frequently at the level of the wrist resulting in a carpal tunnel syndrome. Median nerve entrapment may also occur proximally giving rise to the much less frequent pronator teres syndrome and even less frequent anterior interosseous nerve syndrome, which owing to the paucity of cases may prove challenging to diagnose. An unusual case of anterior interosseous syndrome precipitated by extraordinary exertion in a tetraplegic endurance athlete is presented with ancillary dynamometric, electrodiagnostic, ultrasonographic, and biochemical findings.