Southern medical journal
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Lead toxicity from gunshot wound is a rare complication. It occurs when body fluids, especially synovial cavity fluids, dissolve lead from the bullets, resulting in absorption and toxicity. ⋯ Combination of chelation and surgical removal can result in favorable prognosis. Awareness of this condition allows appropriate diagnostic and therapeutic interventions to be initiated in a timely manner.
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Southern medical journal · Feb 1999
Comparative StudyComparison of the use and accuracy of methods for determining pleural fluid pH.
The blood gas analyzer (BGA) has been considered the "gold standard" for pleural fluid pH determination. ⋯ Clinicians should be encouraged to test selected samples for pleural fluid pH by the BGA when accurate measurements will influence therapy.
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We present the first case of Hantavirus pulmonary syndrome in the Dallas/Fort Worth area. The patient was a 50-year-old previously healthy white man, who had adult respiratory distress syndrome (ARDS) and hypotensive shock after 1 week of nonspecific "viral" symptoms. Despite supportive care, the patient died within several hours of presentation. This case illustrates several of the classic hallmarks of hantavirus infection such as hemoconcentration, thrombocytopenia, ARDS, and shock.
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Southern medical journal · Jan 1999
Case ReportsMarked prolongation of the succinylcholine effect two hours after neostigmine reversal of neuromuscular blockade in a patient with chronic renal insufficiency.
Prolonged neuromuscular blockade from succinylcholine after neostigmine administration has been reported in patients with frank renal failure. We present a case of prolonged neuromuscular blockade from succinylcholine administration, given 2 hours after neostigmine reversal of neuromuscular blockade in a patient with chronic renal insufficiency. This case shows that patients with chronic renal insufficiency, like patients with renal failure, are at risk for prolonged succinylcholine blockade if they have recently received anticholinesterase reversal of neuromuscular blockade. Administration of succinylcholine for facilitation of urgent endotracheal intubation may be required soon after reversal of nondepolarizing muscle relaxants, particularly in patients who return to the operating room for emergency care.
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Southern medical journal · Jan 1999
Case ReportsCat-scratch disease causing status epilepticus in children.
Status epilepticus from cat-scratch encephalopathy is often recalcitrant to usual therapies, causing treatment to focus on critical care management of the patient that may require aggressive interventions, such as continuous pentobarbital administration. We describe two children whose initial clinical presentation of cat-scratch disease was status epilepticus with normal cerebrospinal fluid studies. ⋯ Our two cases and other reports in the literature show a favorable prognosis in most cases, despite the occurrence of status epilepticus. The diagnosis of cat-scratch disease should be strongly considered in all children with unexplained status epilepticus or encephalopathy and serologic testing for Bartonella henselae should be done.