Acute Lead Poisoning: FIVE CASES RESULTING FROM SELF-INJECTION OF LEAD AND OPIUM

Five cases of acute lead poisoning resulted from the self-injectionof lead and opium pills which were crushed, heated and suspendedin water. Two of the five patients died of illnesses in whichhepatic failure and reversible acute tubular necrosis were prominentfeatures. One of these two had a severe neuropathy, with flaccidquadriplegia and respiratory paralysis. The other three patientshad relatively minor symptoms but unequivocal biochemical evidenceof lead toxicity. Autopsy changes included hepatic degenerationwith inclusion bodies, regenerating renal tubular epitheliumand wasting of skeletal muscle. Hepatic lead content was extremelyhigh in one case. Chelation therapy in the other fatal caseresulted in a fall in blood lead to within normal linits anda clinical improvement, which was terminated by massive haemor-rhagefrom a ruptured innominate artery.     

Use of biofeedback in treating chronic hyperhidrosis: a preliminary report

Preliminary findings attesting to the successful therapeutic use of biofeedback training in reducing symptoms of chronic hyperhidrosis are reported. Eleven of the fourteen adult patients trained with biofeedback were able to demonstrate clinical improvement in their excessive sweating 6 weeks after termination of treatment. Relaxation was suggested as the active ingredient in the biofeedback treatment effect. These findings support a recent report of the successful use of biofeedback in treating patients with dyshidrotic eczema.     

Validation of three paediatric pain scores for use by parents

Twenty children undergoing general surgery and 20 children undergoing otorhinolaryngological surgery were simultaneously assessed on two occasions by a doctor and a parent using three pain scoring systems. The pain scoring systems used were the Objective Pain Score, a four point numerical score and a 100 mm visual analogue scale. There was a high correlation between the scores given by the doctor and by the parents for all three scoring systems with parents consistently giving slightly higher scores than the doctor. The correlation coefficients for parental and medical pain scores in recovery were 0.77 for the Objective Pain Score, 0.70 for the four point numerical score and 0.69 for the visual analogue scale (p < 0.01). At 1 h after leaving the recovery area the correlation coefficients were 0.81, 0.80 and 0.73 respectively (p < 0.01). These results suggest that parental scoring of pain in children will be useful in future audit and research of analgesic regimens, particularly in day-case surgery.