Plasma catecholamine levels and neurobehavioral problems in Indian firefighters

Firefighting is a stressful and hazardous job. Persons engaged in firefighting are highly exposed to work-related stress as well as to smoke containing a host of chemicals potentially harmful to human health. In order to elucidate whether firefighting affects neuroendocrine and behavioral responses of firefighters, plasma catecholamine (CA) levels and the prevalence of neurobehavioral symptoms in 62 firefighters (all males, mean age 43 yr) and 52 control subjects matched for age and sex were examined in this study. Self-reported neurobehavioral symptoms data were obtained from a questionnaire survey and personal interview. Concentrations of epinephrine (E), norepinephrine (NE) and dopamine (DA) in plasma were measured by high-performance liquid chromatography with electrochemical detection. Compared with matched controls, the firefighters showed higher prevalence (p<0.05) of neurobehavioral symptoms such as burning sensation in the extremities, tingling and numbness, transient loss of memory, and depression, but no significant difference was recorded in the prevalences of anxiety, vertigo and dizziness. The firefighters demonstrated a more than two-fold (p<0.05) rise in plasma levels of E and NE, but the plasma DA level was relatively unchanged. Controlling age and smoking as possible confounders, firefighting was found to be associated with raised E (OR=2.15; 95% CI, 0.98-4.52), and NE levels (OR=2.24 95% CI, 1.22-3.61). In conclusion, the job of firefighting appears to be associated with stimulation of sympathetic activity and a rise in the prevalence of neurobehavioral symptoms.     

Management of acute 'pink pulseless' hand in pediatric supracondylar fractures of the humerus

The management of a persistent pink pulseless hand after a satisfactory closed reduction in a pediatric supracondylar fracture of the humerus is controversial. Several recent publications have recommended vascular exploration in contrast to a more conservative approach accepted traditionally. We report the results of seven patients with a mean follow-up of 36.6 months with a persistent pulseless, but well-perfused hand postreduction. All patients were managed conservatively without vascular exploration. A palpable return of the radial pulse was seen in six patients at 3 weeks and at 6 weeks follow-up in the other patient with no long-term dysfunction. We believe that the management of a persistent pink pulseless hand remains a 'watchful expectancy'. Surgical exploration should be recommended only if there is either severe pain in the forearm persisting for more than 12 h after the injury or if there are signs of a deteriorating neurological function.     

Massive upper gastrointestinal bleed from epiphrenic diverticulum

Epiphrenic diverticula are outpouchings of the esophagus that retain some or all layers of the esophageal wall. Symptoms such as intermittent dysphagia and vomiting may occur. The authors present a case of an elderly woman with a history of dysphagia who presented with a massive upper gastrointestinal bleed because of a bleeding epiphrenic diverticulum seen at endoscopy who responded to conservative management. Bleeding epiphrenic diverticula should be considered as a cause of upper gastrointestinal bleeding.