1/11. Hyperhomocysteinaemia and upper extremity deep venous thrombosis: a case report.A case is presented of a 24 yr old military aircrew applicant who developed a right axillary subclavian deep venous thrombosis following physical exertion. Investigations revealed damage to the right axillary subclavian venous system and limitation to flow. Coagulation studies also showed an elevated plasma homocysteine level. hyperhomocysteinemia has recently been recognized as a risk factor for venous thromboembolic disease. Damage caused by the thrombosis, the hyperhomocysteinemia and environmental factors encountered in flight, may predispose him to recurrent episodes of thrombosis. This complex case involves aspects of hematology and the nature of coagulation which are only just being elucidated and as yet are poorly understood, and highlights some serious aeromedical implications for pilots afflicted with these conditions.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/11. Hypernatraemia in early infancy.Hypernatraemia, defined as serum sodium > 150 mmol/l, is still seen frequently in tropical environments. We describe two infants, one with poor fluid intake and excessive wrapping and the other with a high solute intake, both of whom presented in a state of severe hypernatraemia. The pathophysiology of this condition is outlined, as are the major causes, such as sodium overload, inadequate water intake, increased water loss of non-renal origin, increased water loss of renal origin and essential hypernatraemia. The literature is reviewed and the current basis for management is appraised and discussed.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/11. Educational strategies used in increasing fluid intake and enhancing hydration status in field hockey players preparing for competition in a hot and humid environment: a case study.The purpose of the present study was to develop a hydration strategy for use by female English field hockey players at the 1998 Commonwealth Games in malaysia. An additional aim was to initiate the process of acclimation. Fifteen elite players, mean age ( /-SEM) 24.1 /- 1.19 years, height 1.67 /- 0.01 m, and body mass 62.8 /- 1.76 kg, took part in a 5-day training camp immediately prior to departure for the Games. In order to develop the hydration strategy, training took place under similar environmental conditions to those to be experienced in malaysia (i.e., 32 degrees C, 80% humidity). Acclimation training consisted of 30-50 min of either continuous, low intensity cycling or high intensity intermittent cycling, which more closely replicated the pattern of activity in field hockey. Body mass measures taken each morning, and pre and post training, together with urine color measures, were used to assess hydration status. Pre-loading with up to 1 L of a 3% carbohydrate-electrolyte solution or water immediately prior to acclimation training, as well as regular drinks throughout, ensured that players avoided significant dehydration, with percent body mass changes ranging from -0.34% to 4.24% post training. Furthermore, the protocol used was sufficient to initiate the process of acclimation as demonstrated by a significant reduction in exercising heart rate and core temperature at all time points by days 4 and 5. In conclusion, although labor intensive and time consuming, the camp was successful in developing a hydration strategy that players were able to utilize once at the Games.- - - - - - - - - - ranking = 5keywords = environment (Clic here for more details about this article) |
4/11. Environmental hyperthermic infant and early childhood death: circumstances, pathologic changes, and manner of death.infant and early childhood death caused by environmental hyperthermia (fatal heat stroke) is a rare event, typically occurring in vehicles or beds. The aims of this study were to describe the demographics, circumstances, pathology, and manner of death in infants and young children who died of environmental hyperthermia and to compare these cases with those reported in the literature. Scene investigation, autopsy reports, and the microscopic slides of cases from three jurisdictions were reviewed. The subjects in 10 identified cases ranged in age from 53 days to 9 years. Eight were discovered in vehicles and 2 in beds. When the authors' cases were grouped with reported cases, the profile of those in vehicles differed from those in beds. The former were older, were exposed to rapidly reached higher temperatures, and often had more severe skin damage. The latter were mostly infants and were exposed to lower environmental temperatures. Hepatocellular necrosis and disseminated intravascular coagulation were reported in victims who survived at least 6 hours after the hyperthermic exposure. The consistent postmortem finding among nearly all victims was intrathoracic petechiae, suggesting terminal gasping in an attempt at autoresuscitation before death. The manner of death was either accident or homicide. Recommendations for the scene investigation are made.- - - - - - - - - - ranking = 3keywords = environment (Clic here for more details about this article) |
5/11. Renal papillary necrosis in kuwait.In 2,158 consecutive routine urograms, 85 patients (51 males and 34 females) were found to have typical changes of renal papillary necrosis, an incidence of 3.9% (2.8% in males, 9.4% in females). The changes were bilateral in 60 patients (71.6%) and unilateral in 25 (29.4%). 3 patients were diabetics, 4 had sickle cell anaemia and 7 had obstructive uropathy. 19 patients admitted to analgesic abuse. The remaining 52 patients were idiopathic but a combination of analgesic abuse and dehydration may have been the cause in this group. The possible reasons for the high incidence of RPN especially in females in this hot desert environment are discussed. The literature on the subject is briefly reviewed.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/11. Occupational risk for nephrolithiasis and bladder dysfunction in a chauffeur.The occupational risks for nephrolithiasis have not been widely studied. The published literature focuses on exposure to heat stress and toxic substances, not on the equally important behavioral risk factor of limited water consumption over many years. Urologic morbidity has been associated with suppressing the need to drink or void under restrictive work environments; however, no such studies link work related behavioral change with the development of kidney stones. This case report is the first to associate a restrictive work environment with limited fluid consumption, resulting in the development of nephrolithiasis.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
7/11. dehydration and heat-related death: sweat lodge syndrome.A 37-year-old Caucasian male died of dehydration and heat exposure following a sweat lodge ceremony in outback australia. The case demonstrates difficulties that may arise in the determination of the cause of death at autopsy due to nonspecific pathologic findings in hyperthermic deaths. There are also a number of features that characterize this particular "sweat lodge syndrome," including prolonged exposure to elevated temperatures in a relatively uncontrolled environment, failure to ensure adequate hydration, failure to appreciate the significance of loss of consciousness, use of ineffective alternative methods of treatment, and delay in seeking appropriate medical care. Unfortunately, the adoption of rituals and practice from other cultures may not be a completely safe undertaking. Participants in this type of activity must be cognizant of the types of medical problems that may arise. Individuals with significant cardiovascular disease, those who are taking certain medications that predispose to hyperthermia, or those who have had large amounts of alcohol should not enter sweat lodges.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
8/11. Managing hypernatremia in fluid deficient elderly.The institutionalized elderly are at risk for developing fluid volume depletion with progression to hypernatremia. This is particularly common in patients transferred to an acute care setting from a nursing home. A marked reduction in intracellular fluid and the increase in body fat associated with normal aging predispose the elderly to water loss with very little environmental prompting. Conditions contributing to the development of fluid volume deficit include febrile illness, utilization of enteral supplements, gastrointestinal bleeding, use of loop diuretics, renal failure, prolonged vomiting, diarrhea, diabetes, and disability induced fluid restriction. This can lead to apathy and confusion, which are often incorrectly attributed to dementia. The utilization of Roy's Adaptation Model to this problem focuses on the regulator subsystem and the physiologic mode.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
9/11. Exertional heatstroke in novice runners.Heatstroke occurred in four apparently normal but inexperienced runners who were involved in road races of 10, 16, 32, and 42 km. Each of the runners attempted to increase his running pace by approximately 1 min/km during the last 5 km of the race. Symptoms of heatstroke occurred within five to ten minutes of the onset of increased effort. In three cases, environmental conditions (temperatures, 24 to 26 degrees C) were contributory. Specific guidelines and instructions are needed for inexperienced runners who enter distance road races.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
10/11. heat stroke: a review.heat stroke is a complex clinical picture caused by extreme elevation of body temperature and is especially prevalent in hot climates. The danger of heat stroke has apparently always accompanied unacclimatized man on his way through arid zones, and was often the cause of man's fatal adventures in the desert. Large numbers of unacclimatized urban dwellers have suffered when the urban areas have been involved in heat waves. heat stroke has also been a major problem in hot industrial environments. This paper is a review of pertinent literature on this subject.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
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