Renal failure after snake bite

Three cases of acute renal failure after snake bite are presented. All required dialysis and the recovery phase was prolonged in each case. Investigations show that microangiopathic haemolytic anaemia was associated with the acute renal failure.     

Snakes and snake bite in Nepal

In this paper the author shows the basic concepts of set theory, which ones are necessary to understand biometric methods. The sets, the most important operations, the power of sets and the types of the used variables are presented.     

An objective approach to antivenom therapy and assessment of first-aid measures in snake bite

Treatment of systemic envenoming in snake-bite victims has, in the past, depended almost entirely on the individual clinician's experience in assessing the severity of envenoming. The efficacy of treatment is obviously related to the neutralizing potency of the antivenom used, the route by which it is administered and the dose. The development of enzyme immunoassays has permitted a more scientific appraisal, allowing estimation of circulating specific venom and antivenom concentrations at any time after the bite in the patient's blood. It is therefore possible to measure accurately the efficacy of antivenom in the neutralization and clearance of venom antigen. In Brazil, it appears that clinicians treat patients with excessive amounts of highly efficient antivenoms and this results in an unacceptably high incidence of reactions. In Sri Lanka, the use of imported, Indian antivenom is relatively ineffective in neutralizing the venoms of Sri Lankan snakes, demonstrating the real problem of venom variability within individual species. In West Africa, the improved clearance of venom following treatment of Echis victims with a monospecific as opposed to a polyspecific antivenom has been demonstrated, and new, smaller fragment, Fab antivenoms have been developed and are now under clinical assessment. Such clinically-based immunological studies should result in more efficient and controlled use of expensive antivenoms for treatment of systemic envenoming and the accurate assessment of newly designed products. Such studies also emphasise the importance of individual countries producing their own antivenoms for treatment of systemic envenoming. Likewise, the use of such objective systems now enables the use of first-aid measures such as tourniquets to be properly assessed.     

An unusual presynaptic action of Bothrops insularis snake venom mediated by phospholipase A2 fraction

A phospholipase A2-containing fraction was isolated from the venom of Bothrops insularis by a combination of gel filtration on Sephadex G-150 and ion exchange chromatography on DEAE-Sephadex. Peak IV of the latter chromatography containing all of the phospholipase A2 (PLA2) activity, was assayed on isolated neuromuscular preparations. In the mouse phrenic nerve-diaphragm incubated in Tyrode at 37 degrees C, the PLA2 fraction produced an initial increase in the twitch tension and in the frequency of the mepps, followed by a dose-dependent, irreversible blockade. The replacement of 1.8 mM Ca2+ by 4 mM Sr2 inhibited the neuromuscular blocking effect of the fraction. In the chick hiventer cervicis preparation incubated with Krebs solution at 37 degrees C, the PLA2 fraction induced blockade but did not affect the response to acetylcholine and K+, excluding the involvement of post-synaptic and direct muscular effects. A low temperature (18-22 degrees C) incubation prevented the neuromuscular effect from developing. These results suggest that the PLA2-containing fraction acts predominantly at presynaptic sites at the neuromuscular junction. This fraction also accounts for most of the pharmacological effects of the crude venom.     

An unusual form of macrodactyly

The authors report a rare case of macrodactyly of the thumb in a 36 year old woman. The hypertrophy predominates on the epiphyseal tissue with complete ankylosis of the trapezo-metacarpal joints. The metacarpo-phalangeal joint and interphalangeal joints in an abnormal position. This results total functional incapacity of the thumb. The cosmetic and psychological impact are important to consider. Treatment consisted of two operative procedures. First a silastic implant for the trapezo-metacarpal joint and an arthrodesis of the metacarpophalangeal joint in a normal position was done. Three months later, the volume of the thumb was reduced by a longitudinal bone resection. The functional and cosmetic result are being assessed. The literature is reviewed and the different modes of treatment utilised in such a malformation is presented. A relation between macrodactyly and lipomatous macrodystrophy is considered.