1/4. Successful transplantation of donor organs from a hemlock poisoning victim.BACKGROUND: The poison hemlock plant (conium maculatum) has been a known poison since early in human history, most notably as the agent used for the execution/suicide of Socrates in ancient greece. No experience has been reported regarding the suitability of a hemlock victim's organs for transplantation. methods AND RESULTS: This report documents successful transplantation of the liver, kidney, and pancreas from a 14-year-old girl who died of anoxic encephalopathy from asphyxia after the accidental ingestion of fresh hemlock while on a nature hike. Predonation laboratory values were not remarkable, and liver and kidney biopsy results were normal. All organs in the three recipients had immediate function, and no recipient had any clinical evidence of transmitted toxin. All recipients are well, with functioning transplants at greater than 6 months after transplantation. CONCLUSIONS: Poison hemlock intoxication does not seem to be a contraindication to organ donation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/4. Sinus vein thrombosis following exposure to simulated high altitude.A relation exists between high altitude exposure and a hypercoagulable state, the nature of which is not entirely clear. This has been mostly reported in mountain climbers. We report a 19-yr-old female, working as a high-altitude chamber instructor, who presented with severe frontal headaches which persisted for a month following routine high altitude chamber training. The patient was in generally good health and was using oral contraceptives for 3 yr prior to the event. Due to the unremitting nature of the symptoms, the patient was admitted to a neurology department, and computerized tomography (CT) and magnetic resonance imaging (MRI) were performed. Sagittal and transverse sinus vein thrombosis were diagnosed and anticoagulant therapy was initiated (low molecular weight heparin followed by warfarin). Following treatment, a slow symptomatic improvement was observed, and the patient was discharged. On discharge, it was recommended she continue oral anticoagulant therapy (warfarin). A complete coagulation screening panel was performed, which was negative. Although the relation between high altitude exposure and a hypercoagulable state is well known, this is the first time a case of sinus vein thrombosis has been reported after high altitude chamber training. Careful history and closely monitored medical follow-up should be performed on all designated staff exposed to simulated altitude. Even though there is no conclusive evidence regarding it, we suggest, as a matter of caution, that women using oral contraceptives should consider their risks before deciding to undertake exposure to simulated altitude in chambers. literature review and detailed recommendations for prevention are provided.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
3/4. The incidence and spectrum of neurological injury after open fetal surgery.A preterm infant's immature brain is susceptible to both anoxic and hemorrhagic injury during periods of physiological stress. The advent of in utero surgery has created a new population of premature patients at risk for central nervous system (CNS) injury. The aim of this study was to evaluate the frequency and nature of CNS injuries in fetal surgical patients. Of 33 fetuses with known neurological outcome after fetal surgery, CNS injuries were identified in seven (21%). Of the seven, four had significant episodes of fetal bradycardia (3) or neonatal hypotension (1), which suggests that asphyxia contributed to the neurological injury. The CNS injuries in the other three patients occurred unexpectedly and without associated signs of fetal distress. The authors speculate that these injuries may have been caused by sudden fluxes in cerebral blood flow, induced by maternal hypoxia (1) or by maternally administered tocolytic drugs (2) used to treat postoperative preterm labor.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/4. Cerebral oxygenation and the recoverable brain.Oxygenation is the most critical function of blood flow and a sudden reduction in oxygen availability is an inevitable consequence of severe ischemia. The resulting cascade of events may result in the failure of membrane integrity of some cells and necrosis, but in the surrounding zone of tissue, less affected by hypoxia, cells survive to form the ischemic penumbra. The timing of these events is uncertain, but sufficient oxygen is available to these cells to maintain membrane ion pump mechanisms, but not enough for them to generate action potentials and therefore function as neurons. The existence of such areas has been suspected for some time based upon the nature of clinical recovery, but has now been demonstrated by SPECT imaging with a high plasma oxygen concentration under hyperbaric conditions as a tracer. A course of hyperbaric oxygen therapy frequently results in a permanent improvement in both flow and metabolism. These changes apparently represent a reversal of the changes that render neurones dormant and the activity of cells, previously undetectable by standard electrophysiological methods, can now be demonstrated. Three patients are presented in whom recoverable brain tissue has been identified using SPECT imaging and increased cerebral oxygenation under hyperbaric conditions. Improved perfusion from reoxygenation has correlated with clinical evidence of benefit especially with continued therapy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |