The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society
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The performance of bilateral supraclavicular brachial plexus nerve blocks is controversial. We present the challenging case of a 29-year-old male who suffered bilateral high-voltage electrocution injuries to the upper extremities, resulting in severe tissue damage, sensory and motor deficits, and wounds in both axillae. This injury necessitated bilateral below-elbow amputations. ⋯ Our concerns with this approach included the risks of pneumothorax and respiratory failure due to phrenic nerve block. Initial attempts at brachial plexus blockade using nerve stimulation were unsuccessful; therefore, ultrasound guidance was employed. With vigilant monitoring in an intensive care unit setting, we were able to safely perform bilateral continuous supraclavicular brachial plexus nerve blocks with an excellent analgesic response and no noted complications.
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Case Reports
Distal ventriculoperitoneal shunt catheter migration to the right ventricle of the heart--a case report.
Ventriculoperitoneal shunts (VPS) have few complications other than mechanical obstruction and infection. A VPS catheter located in the chest is a rare complication, while intracardiac catheter migration is rarer still. ⋯ Negative inspiratory pressure and orthograde blood flow may then draw the catheter proximally through a vein and eventually to the heart or pulmonary artery. We discuss the mechanisms and management of this rare, yet dangerous, complication of a routine neurosurgical procedure.
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Methadone maintenance treatment (MMT) is commonly used for chronic pain control and for substitution in heroin addicts undergoing rehabilitation. Methadone is known to prolong QT interval and sometimes cause torsade de pointes (TdP) and ventricular fibrillation (VF). ⋯ To our knowledge, worsening of methadone-induced TdP by amiodarone has not been reported before. We describe here a case of methadone-induced TdP that deteriorated into ventricular fibrillation upon treatment with intravenous (IV) amiodarone and resolved after discontinuation of amiodarone and treatment with IV magnesium, potassium, and lidocaine.
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This epidemiological review analyzed cases of Naegleria fowleri primary amebic meningoencephalitis (PAM) and Balamuthia mandrillaris granulomatous amebic encephalitis (GAE) for behavioral and demographic risk factors for pathogen exposures and potential transmission by organ transplantation. The Centers for Disease Control and Prevention (CDC) Naegleria Workgroup Registry provided 121 cases of laboratory-confirmed PAM over the period, 1937-2007. The CDC and the California Encephalitis Project provided 28 cases of GAE over the period, 1994-2010. ⋯ Risk factors for GAE included male gender, exposures in southern-tier US states, Hispanic ethnicity in California, occupational or recreational contacts with soil, and recent organ transplantation. Fatal free-living amebic infections of the brain are increasing today due to more frequent environmental, recreational, and occupational exposures; organ transplantation; and unanticipated clusters of PAM due to N. fowleri inoculations following nasal sinus irrigation using neti pots filled with municipal tap water. Potential organ donors dying from meningoencephalitis of unexplained causes should be screened for free-living amebic infections of the brain capable of hematogenous dissemination in organ recipients.