The West Virginia medical journal
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Ethylene glycol (EG) and methanol (MTH) are common industrial solvents and are responsible for accidental, suicidal, and epidemic poisonings.1 Since the clinical signs and symptoms associated with EG and MTH poisoning are nonspecific, it is important for the medical community to consider these toxicities given that early treatment prevents death.2 The hallmark of toxic alcohol poisoning is a combination of a high anion gap metabolic acidosis and osmolar gap.3 In order to determine laboratory abnormalities and outcomes associated with EG and MTH ingestion at our institution, a retrospective chart review was obtained. ⋯ Most patients with EG and MTH intoxication have a decreased level of consciousness making an adequate history unobtainable. One must rely on laboratory data for clues in making a diagnosis of intoxication. A review of the clinical features, pharmacokinetics, laboratory analysis, and management of EG and MTH poisoning is included in this discussion to help raise medical community awareness of this entity.
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Review Case Reports
Spinal cord stimulation as a method of reducing opioids in severe chronic pain: a case report and review of the literature.
Opioid addiction and abuse are growing problems in the United States, particularly in Appalachian areas, which has led to a major social health problem costing millions of dollars in lost wages, medical care and lost productivity. In some patients with chronic moderate to severe pain, opioids are indicated and can be successfully used with proper monitoring. In this report, we present a case where the use of spinal cord stimulation (SCS) led to an elimination of opioids, a return to work, and to productive function. We also review the literature on the use of SCS to reduce opioid use and improve function based on objective criteria.
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Though it is our ethical imperative to minimize discomfort, physicians often struggle to manage pain effectively, mainly due to time constraints, lack of training, and fear of litigation regarding over-prescribing of controlled substances. In addition, physicians also now must face potential litigation for under treatment of persistent pain. This dilemma often leaves the physician with a sense of insecurity and stress. ⋯ In the elderly, since abuse potential is less likely and disease documentation is often more readily apparent, we feel relatively comfortable in initiating careful prescribing of opioid therapy early on. As we become more adept at our approach toward pain management issues, we will attempt some assessment of outcomes by observing changes in several parameters, including numbers of opioid prescriptions and comparative adequacy of pain control over time. National and local pain/addiction information and referral resources are available as follows: http:// www.nationalsubstanceabuseindex .org and http://www.wvupc. org/charleston/painlist.
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The brachial plexus consists of nerve roots C5-T1. Upper brachial plexus roots (C5-C6) innervate proximal muscles of the shoulder and upper arm. ⋯ Upper brachial plexus reconstruction using nerve transfers is a new method to bypass damaged areas thereby allowing patients to regain critical arm functions faster. We present a review of brachial plexus cadaveric anatomy, reconstruction transfer techniques, and management.