摘要:

Glue sniffing refers to the deliberate inhalation of volatile solvents, commonly found in adhesives, for the purpose of intoxication. The increasing prevalence of inhalant use suggests that many physicians will encounter a glue-sniffing patient at some time during their practice. Knowledge of the epidemiology, toxicology, and medical complications associated with glue sniffing is essential in obtaining an accurate history of substance abuse and in clinically managing these patients. This review of sources is intended to aid clinicians in the recognition of glue-sniffing patients and in the diagnosis of acute and chronic medical complications associated with the abuse of glues, solvents, and related substances. Glue sniffing has been linked to sudden death and chronic damage to the heart, lungs, kidneys, liver, peripheral nerves, and brain. Inhalant abuse in general is associated with mortality and morbidity, including social, educational, and economic deprivation in adolescents and young adults.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Patients with diabetes are at risk for multiple visual complications, most notably diabetic retinopathy, but also glaucoma, cataracts, optic nerve disease, and strabismus. Diabetic retinopathy is the leading cause of blindness for the majority of Americans. Microvascular damage from diabetes leads to microaneurysms, hemorrhage, exudates, and cotton-wool spots. Further progression of disease leads to new vessel growth, or neovascularization. Growth of new blood vessels can cause severe hemorrhage, scarring, and permanent visual loss. Various randomized, prospective studies have clearly shown benefit from laser therapy at specific stages of progression of retinopathy. Proper referral and close follow-up are paramount to the preservation of visual function.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Medical inpatients in inner-city hospitals have both potentially lead-related disorders and potential lead exposure. To see whether there is substantial unexpected lead intoxication in this population, we did a cross-sectional study of 117 consecutively admitted patients to a general medical ward of an inner-city university hospital. The mean (SD) blood lead level was 6.7 (2.8) µg/dL, with a range of 0 to 37 µg/dL. Twenty-one patients (18%) had mildly elevated lead levels (10 to 19 µg/dL) and 2 patients (2%) had moderately elevated lead levels (20 to 44 µg/dL). Only 1 of 117 patients (0.9%, 95% CI: 0.0% to 2.6%) had lead intoxication (a lead level ≥20 µg/dLora lead level ≥15 ug/dLanda free erythrocyte protoporphyrin level >90 µg/dL of erythrocytes, with no alternative explanation for the laboratory abnormalities). We conclude that lead intoxication is uncommon in this population and that routine screening is not warranted. Although mild elevation of blood lead level is common, the clinical significance remains to be determined.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Originally used in warfare, air guns are commonly used in target shooting, as toys, and as "beginner" guns for children. The projectile force of these weapons can rival that of many conventional handguns. Pneumatic weapons pose a serious threat to the pediatric population, and their potential for serious injury must be recognized.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Systemic inflammatory response syndrome (SIRS) is characterized by body temperature abnormalities, tachypnea or hyperventilation, tachycardia, and leukocytosis or leukopenia. Although it is typically associated with a serious infection and referred to as sepsis, SIRS can stem from noninfectious causes, as well. We report the cases of four patients with toxic serum levels of salicylate (33.5 to 67.6 mg/dL) and SIRS, and we discuss mechanisms responsible for SIRS. Our patients showed temperature disturbances (35.5°C to 39.8°C), noncardiogenic pulmonary edema, and mixed acid base disturbances. Other abnormalities included coagulopathy (disseminated intravascular coagulation), encephalopathy, and hypotension. All four patients recovered from SIRS, probably due to early recognition and treatment; only one patient did not survive the hospitalization. Chronic salicylate toxicity should be considered as a cause of SIRS in the absence of a source of infection, since survival appears to be dependent on prompt diagnosis and management.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The first goal of this Nebraska-based study was to determine physician reporting of patient complaints about sleep. The second goal was to determine the patterns of referral to sleep disorders laboratories by geographic location and specialty practice. A total of 299 Nebraska physicians (177 in urban areas and 122 in rural areas) completed a questionnaire concerning sleep complaints among patients. We found no statistically significant differences between urban and rural physicians in the percentage of patients reporting insomnia, excessive daytime sleepiness, snoring, or other sleep complaints. Psychiatrists reported on significantly more patients with insomnia and excessive daytime sleepiness than did other physicians; however, they tended to refer fewer patients to sleep disorders laboratories than did physicians practicing internal medicine. Urban physicians referred significantly more patients to sleep disorders laboratories than did rural physicians. We concluded that physician reporting of patient complaints about sleep is similar in urban and rural areas of Nebraska. However, physicians in rural areas tend to refer fewer patients to sleep disorders laboratories than do physicians in urban communities.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A retrospective chart review of all cases of suspected epiglottitis from 1985 to 1993 at Arkansas Children's Hospital identified 29 patients treated for epiglottitis during this 9-year period. Review of the immunization status of these patients showed 72% without Hib vaccination, 11% who had initiated the Hib series, and 17% with unknown immunization status. The incidence of epiglottitis declined over the duration of the study with 0.61/1,000 admissions in 1985, 0.27 in 1986, 1.42 in 1987, 0.9 in 1988, 0.39 in 1989, 0.0 in 1990, 0.35 in 1991, 0.0 in 1992, and 0.0 in 1993. Comparing the years before available conjugate vaccine—1985 to 1988—with the years after conjugate vaccine—1989 to 1993—shows a significant change in the incidence of epiglottitis. With increasing populations of susceptible children receiving Hib immunization, Hib epiglottitis may become a vanishing entity.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Visceral leishmaniasis is endemic in Pakistan. No studies of visceral leishmaniasis in childhood have been reported from Pakistan. We prospectively studied clinical and laboratory features in 58 Pakistani children with visceral leishmaniasis. Mean age of the children was 2.9 years. Fever, pallor, and abdominal distention were the most common clinical manifestations, and hematologic abnormalities were the most common laboratory findings. All children recovered after antimicrobial therapy. Pakistani children with visceral leishmaniasis tended to be younger than affected children from Africa and were less likely to have lymphadenopathy.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Chest trauma in children is a marker of injury severity and is associated with a high mortality rate. This retrospective study of 1,356 trauma patients from a private pediatric hospital over a 2.5-year period identified 82 patients with chest injuries and a mortality rate of 22%. Results of Injury Severity Score, Glasgow Coma Scale, and Revised Trauma Score all indicated that children with chest injuries sustained more severe injuries. The presence of any extrathoracic injury was associated with a higher mortality (29%) than chest injury alone (4.3%). The type of extrathoracic injury was important, with head and neck injuries resulting in the highest mortality. Specific chest injuries, such as rib fractures and pulmonary contusions, were not related to increased mortality unless there was an associated extrathoracic injury. Many reports have shown a high mortality associated with chest trauma. This study suggests that it is the associated extrathoracic injury, rather than the chest injury itself, that is the real cause of the high mortality.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We retrospectively analyzed 36 patients requiring temporary abdominal wall closure on admission to a level I trauma center from 1988 to 1992. There were 10 deaths (28%) in the study population. Of the 26 survivors, 8 patients (31%) had primary fascial closure at initial hospitalization, whereas 18 patients (69%) required split-thickness skin grafting to visceral granulation tissue. Of these 18 patients, 13 have had ventral herniorrhaphy at subsequent admission. Eight of these patients had primary fascial closure, 4 required primary fascial approximation with prosthetic onlay reinforcement, and 1 required multiple operations including prosthetic reconstruction and eventual complex tissue transfer. Complications occurred in 3 patients (14%) and included two wound seromas, which were drained nonoperatively, and a wound infection necessitating removal of prosthetic material and subsequent reconstruction with complex tissue transfer. Follow-up reveals no recurrent hernia at 24 months. Abdominal wall reconstruction after temporary closure can be done safely and promptly, with good functional and esthetic results.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID