Fatal grand mal seizure in a Dutch trekker

In Trinity Hospital, a district hospital in the south of Malawi, over a period of 4 years 60 patients were admitted following injury by crocodiles. All patients were treated by extensive surgical cleaning and debridement, anti-tetanus treatment and broad spectrum antibiotics. Twenty-four patients (40%) had serious injuries resulting in permanent deformity. Only one patient died from sepsis.     

Cochlear implantation in a patient with grand mal epilepsy

PURPOSE: The authors introduced a successful trial of a chemotherapy regimen to treat refractory thrombocytopenia and pain caused by a rare kaposiform hemangioendothelioma that had been refractory to corticosteroids. PATIENT AND METHOD: A 6-year-old Latina girl with diffuse petechiae, constant pain and edema in her right lower extremity, and severe thrombocytopenia was brought for treatment. Physical examination revealed a large mass in the right lower extremity. The surgical specimen resected earlier in Mexico showed kaposiform hemangioendothelioma, an extremely rare vascular tumor that is frequently associated with consumptive coagulopathy and lymphangiomatosis. Corticosteroid therapy in Mexico had been ineffective in controlling the tumor size, pain, or thrombocytopenia. The patient was brought to the United States because of a rapidly enlarging tumor and intractable leg pain, causing inability to ambulate. Laboratory examinations revealed profound thrombocytopenia and evidence of consumptive coagulopathy. Because of the rapidly enlarging lesion, it was decided to give six cycles of a chemotherapy regimen consisting of vincristine, cyclophosphamide, and actinomycin D (VAC). RESULT: The patient responded to the first cycle of chemotherapy with partial reversal of the thrombocytopenia. The additional five cycles of the same chemotherapy regimen resulted in complete resolution of thrombocytopenia and significant improvement of the pain and edema in the right lower extremity. A follow-up imaging study 9 months later revealed a marked decrease in size of the vascular tumor. CONCLUSION: Inoperable kaposiform hemangioendothelioma unresponsive to corticosteroids can be successfully treated with chemotherapy.     

Dislocation of great toe phalangeal joint due to a grand mal seizure

Fetal mouse calvarias were cultured in a medium containing fetal calf serum, 1,25(OH)2D3 and parathyroid hormone in 5% CO2 incubator at 37 degrees C for 5 days. The calvarias were then fixed in a buffered paraformaldehyde solution and the periostea were removed. A polyclonal antibody against transforming growth factor-beta (TFG-beta) and a second antibody labeled with fluorescein isothiocyanate were used to detect TGF-beta. As a result, a specific staining was observed only in the shielding zone covered by osteoclasts in the bone resorption lacunae and in the extracellular matrix adjacent to the osteoclasts. These findings suggested the local delivery and possible activation of TGF-beta by osteoclasts in tissue.     

Simultaneous bilateral fractures of the hip following a grand mal seizure. An unusual complication

Pathological fractures as a consequence of convulsive seizures without direct trauma occur in 0.3% of cases. Some lesions such as bilateral posterior dislocation of the shoulder, fracture-dislocation of the shoulder or fracture and/or dislocation of the hip strongly suggest a seizure as the aetiology. We report on a patient with simultaneous central dislocation of one hip with fracture of the contralateral femoral neck provoked by spontaneous seizures. Unrecognized associated injuries following a convulsion may result in long-term functional disability and legal consequences.     

The connection between absence-like seizures and hypothermia induced by penicillin: possible implication on other animal models of petit mal epilepsy

In this study we investigated the relationship between penicillin-induced hypothermia and petit mal epilepsy induced by this proconvulsant antibiotic. In order to find a possible dose-dependent relationship, we used two doses: 1500.000 and 1000.000 U/kg b.wt., both known as being sufficient to induce absence-like attacks with subsequent spike and wave discharges (SWD) in electrocorticogram (ECoG). Because of experimental data suggesting penicillin binding to benzodiazepine receptor recognition site, we also studied penicillin-induced changes in body temperature after diazepam pretreatment. Results of this study clearly show that penicillin in doses known to induce petit mal-like epilepsy concomitantly induces statistically significant dose-dependent decrease in body temperature. Pretreatment with diazepam completely prevents both penicillin-induced hypothermia and SWDs. On the other hand, both the diazepam and mixed diazepam + penicillin treatments did not significantly alter body temperature. These results suggest, however, that at least some of the penicillin effects described could be assigned to its binding to the benzodiazepine receptor recognition site at GABA(A) ionophore. This may have an important clinical implication because the inhibitory action of penicillin at the benzodiazepine receptor recognition site could account for the mechanism of penicillin-induced unspecific encephalopathies in humans. The relationship between petit mal epilepsy and hypothermia sheds new light on the action mechanisms of penicillin-induced absence seizures.     

Organizational problems in emergency medical care and reorganization of emergency services in hospitals

Entropic properties of the neural signal space, the neurodynamic basis of Weber's and Steven's law. Acta Physiol. Pol., 1977, 28 (2): 113--116. Taking into account the number of neural units, number of their efferent synapses and the average impulse frequency as well as the notion of neural momentum the dependence of neural entropy on neural tonus was examined. Based on the above model the neurodynamic basis of the Weber's and Steven's law was considered.     

Critical care in an emergency department

A one year review of resuscitation in an emergency department (ED) was conducted. In the stabilization room (SR) within the ED at Hennepin County Medical Center, 852 cases were treated in the year ending July 31, 1978. There were 166 deaths in the SR (19.5%) overall, and 141 (47.9%) and 16 (5.3%) for cardiac and trauma cases, respectively. The 32 fatal cases of blunt trauma (six in the SR, 10 within 24 hours, and 16 late deaths) were reviewed and assigned an injury severity score (ISS). Of these, 12 deaths were unrelated to central nervous system causes. These had an average ISS of 42.8.     

The clinical outcome in pregnancies of grand grand multiparous women

Recent public health concern about the Jacob-Creutzfeld disease related to administration of growth hormone in children or the "mad cow" disease in cattle fed contaminated products requires a review of the association between Jacob-Creutzfeldt disease and pregnancy. Four cases of this transmissible spongiform encephalopathy have been described in pregnant women and none of the offspring, currently 22, 10, 7 and 3 years of age, have developed the disease. Vertical transmission of Jacob-Creutzfeldt disease cannot however be excluded as it occurs in animals and since injections of cord blood and placenta extracts of women with this disease into mice brains has proven the presence of the infectious agent. The rarity of Jacob-Creutzfeldt disease in women of reproductive age and the particularly long incubation period of this type of encephalopathy would incite prudence and long-term follow-up to determine outcome in children born from disease women or who developed signs of the disease during the years following delivery.