Serious complication after subcutaneous injection of heparin for prophylaxis of thromboembolism. Case report

Subcutaneous application of low-dose heparin before and after surgery is a routine procedure to avoid thromboembolic complications. Advances in development of anticoagulants, reduction of intervals between applications, modern injection tools,and training of the personnel have already reduced the incidence of severe complications. However, the case presented shows impressively that a life-threatening complication is still possible and has to be kept in mind in perioperative thrombosis prophylaxis. After postoperative subcutaneous injection of low-dose-heparin in the right lower abdominal wall, a 76-year-old female patient suffered from an extensive,hemodynamically active hematoma located in the M.rectus abdominis as a sequela of perforating the A. epigastrica superficialis.Consequently hypovolemic shock led to cardiopulmonary circulatory arrest.After immediate resuscitation, surgical hemostasis was performed and the hematoma was removed. Post-interventional stabilization of circulation and wound healing were trouble free.     

Is human sentence parsing serial or parallel? Evidence from event-related brain potentials

In this ERP study we investigate the processes that occur in syntactically ambiguous German sentences at the point of disambiguation. Whereas most psycholinguistic theories agree on the view that processing difficulties arise when parsing preferences are disconfirmed (so-called garden-path effects), important differences exist with respect to theoretical assumptions about the parser's recovery from a misparse. A key distinction can be made between parsers that compute all alternative syntactic structures in parallel (parallel parsers) and parsers that compute only a single preferred analysis (serial parsers). To distinguish empirically between parallel and serial parsing models, we compare ERP responses to garden-path sentences with ERP responses to truly ungrammatical sentences. Garden-path sentences contain a temporary and ultimately curable ungrammaticality, whereas truly ungrammatical sentences remain so permanently--a difference which gives rise to different predictions in the two classes of parsing architectures. At the disambiguating word, ERPs in both sentence types show negative shifts of similar onset latency, amplitude, and scalp distribution in an initial time window between 300 and 500 ms. In a following time window (500-700 ms), the negative shift to garden-path sentences disappears at right central parietal sites, while it continues in permanently ungrammatical sentences. These data are taken as evidence for a strictly serial parser. The absence of a difference in the early time window indicates that temporary and permanent ungrammaticalities trigger the same kind of parsing responses. Later differences can be related to successful reanalysis in garden-path but not in ungrammatical sentences.     

Necessary steps for implementing the Australian DRG system

The introduction of the DRG-System will be followed by severe changes in the German hospitals. From the view of today departments or hospitals are threatened by closing if they do not deal with the new rules. A common implementation of this system by all participants of the health system is necessary before the introduction at 1.1.2003. Only this will guarantee an adequate presentation of the different defaults in the future because the conditions of the implementation of the system are not qualified yet. The hospitals are forced to prepare the introduction of the DRG-System, however. Only the Arrangement of an extensive documentation of all diagnoses and all conservative and operation methods together with a cost--cutting administration will be consequently followed by a financial healthy situation. The most important points to be emphasized are the medical documentation, the controlling, the improvement of the processes and the computer assisted documentation. By an intensive information concerning all further resources the involvement of the employees of the hospital is a necessary part for the success of the introduction.     

Mental health first aid training for the Chinese community in Melbourne,Australia: effects on knowledge about and attitudes toward people with mental illness

Background  

The aim of this study was to investigate in members of the Chinese community in Melbourne the impact of Mental Health First Aid (MHFA) training on knowledge about mental disorders and on attitudes to people with mental illness. The hypotheses were that at the end of the training participants would have increased knowledge of mental disorders and related treatments, and decreased negative attitudes towards people with mental disorders.     

Increased risk of sensory neuropathy in workers with chloracne after exposure to 2,3,7,8-polychlorinated dioxins and furans

OBJECTIVE: The existence of a peripheral neuropathy after exposure to polychlorinated dioxins (PCDD) is still discussed, as studies concerning dioxin effects on the peripheral nervous system are rare and contradictory. MATERIAL AND METHODS: Clinical and neurophysiological examinations (motor conduction velocity of the peroneal nerve, sensory conduction velocities of the sural and ulnar nerves) were made in 156 dioxin exposed workers (42 with, 114 without cloracne) from one pesticide producing plant. Because of known risk factors for peripheral neuropathy, 7 workers with and 28 without cloracne were excluded from further analysis. RESULTS: Workers with chloracne had a significantly higher exposure against PCDD as documented by back calculated lipid levels. They complained significantly more often of sexual impotence (28.6% compared to 5.8% of workers without chloracne, P<0.001), had significantly more frequent clinical signs of a sensory neuropathy (= abnormal sensory findings plus deep tendon reflex abnormalities) restricted to the legs (17.1% compared to 1.2%, P<0.001), had significantly more frequent > or =2 neurophysiologic abnormalities (34.3% compared to 14.0%, P<0.025), and had significantly lower mean amplitudes of the motor compound muscle potential of the peroneal nerve. CONCLUSION: PCDD has a mild toxic effect on the peripheral nervous system manifesting as mild sensory neuropathy of the legs in a minority of the most severely exposed persons.     

Abolished laser-evoked potentials and normal blink reflex in midlateral medullary infarction

We investigated two patients presenting with the rare finding of almost isolated hemianalgesia with a sensory level on the contralateral side sparing the face. Clinical findings, electrophysiological studies (absent laser-evoked pain-related somatosensory potentials, normal electrically evoked somatosensory potentials, magnetically evoked potentials, and blink reflexes), and magnetic resonance imaging showed the ventrolateral medullar tegmentum containing the spinothalamic tract to be affected by lacunar infarction. The blink reflex R2 component was unimpaired in both patients. Received: 7 May 1998 Received in revised form: 21 July 1998 Accepted: 26 August 1998     

The effect of long-term ethanol treatment on the polysome profile of brain, liver, and kidneys of mice

Female mice were fed ad libitum with a liquid diet containing5% (w/w) ethanol. After 4–8 weeks the polysome profileof brain, liver and kidneys showed changes indicating an increasedstate of aggregation.