Successful outcome after intravenous gasoline injection

Introduction

Gasoline, ingested intentionally or accidentally, is toxic. The majority of reported cases of gasoline intoxication involve oral ingestion or inhalation. Data are scarce on complications and outcomes following hydrocarbon poisoning by intravenous injection.

Case Report

Following a suicide attempt by intravenous self-injection of 10 ml of gasoline, a 26-year-old medical student was admitted to the intensive care unit (ICU) with hemoptysis, symptoms of acute respiratory failure, chest pain, and severe abdominal cramps. Gas exchange was severely impaired and a chest x-ray indicated chemical pneumonitis. Initial treatment consisted of mechanical ventilation, supportive hyperventilation, administration of nitrogen oxide (NO), and prednisone. Unfortunately, the patient developed multi-organ dysfunction syndrome (MODS) complicated by life-threatening severe vasoplegia within 24 hours after gasoline injection. High doses of vasopressors along with massive amounts of parenteral fluids were necessary. Despite fluid replacement, renal function worsened and required hemofiltration on 5 sequential days. After 12 days of intensive care management, the patient recovered completely and was discharged to a psychiatric care facility.

Discussion

Intravenous gasoline injection causes major injury to the lungs, the organ bearing the first capillary bed encountered. Treatment of gasoline poisoning is symptomatic because no specific antidote is available. Early and aggressive supportive care may be conducive to a favorable outcome with minimal residual pulmonary sequelae.     

Comparison of 3 different multianalyte point-of-care devices during clinical routine on a medical intensive care unit

Purpose

Multianalyte point-of-care (POC) devices are important to guide clinical decisions in critical care. However, the use of different devices in one hospital might cause problems. Therefore, we evaluated 3 commonly used POC devices and analyzed accuracy, reliability, and bias.

Methods

Seventy-four arterial blood samples were analyzed by 3 POC devices (Cobas, Roche Diagnostics, Mannheim, Germany; ABL800 Flex, Radiometer GmbH, Germany; Gem Premiere, Instrumentation Laboratory, Germany). For selected parameters, samples were also analyzed in the central laboratory. pCO2, pO2, SO2, bicarbonate and standard bicarbonate, sodium, potassium, calcium, pH, lactate, base excess (BE[B] and BEecf), glucose, hemoglobin, and hematocrit were compared.

Results

For most parameters, only minor, although statistically significant, changes were observed between the POC devices. For pO2, BE(B), hemoglobin, and hematocrit, clinically significant differences were found.

Conclusion

Although POC devices are of high standard and overall comparability between devices is high, there might be a clinically relevant bias between devices, as found in our study for pO2, BE(B), hemoglobin, and hematocrit. This can be of importance when interpreting results of the same patient obtained from different POC devices, as it could happen when a patient is transferred within a hospital where different devices are used.     

Iatrogenic ulnar nerve injury after pin fixation and after antegrade nailing of supracondylar humeral fractures in children

Background and purpose

Ulnar nerve injury may occur after pinning of supracondylar fractures in children. We describe the outcome and compare the rates of iatrogenic injuries to the ulnar nerve in a consecutive series of displaced supracondylar humeral fractures in children treated with either crossed pinning or antegrade nailing.

Methods

Medical charts of all children sustaining this fracture treated at our department between 1994 and 2009 were retrospectively reviewed regarding the mode of treatment, demographic data including age and sex, the time until implant removal, the outcome, and the rate of ulnar nerve injuries.

Results

503 children (55% boys) with an average age of 6.5 years sustained a type-II, type-III, or type-IV supracondylar fracture. Of those, 440 children were included in the study. Antegrade nailing was performed in 264 (60%) of the children, and the others were treated with crossed pins. Iatrogenic ulnar nerve injury occurred in 0.4% of the children treated with antegrade nailing and in 15% of the children treated with crossed pinning. After median 3 (1.6–12) years of follow-up, the clinical outcome was good and similar between the 2 groups.

Interpretation

Intramedullary antegrade nailing of displaced supracondylar humeral fractures can be considered an adequate and safe alternative to the widely performed crossed K-wire fixation. The risk of iatrogenic nerve injury after antegrade nailing is small compared to that after crossed pinning.In children, supracondylar fractures are the most common type of fracture of the elbow region (Omid et al. 2008). Boys usually have a higher incidence of this type of fracture but some recent reports in the literature describe rising rates in girls (Cheng et al. 2001). Most of the patients are 5–7 years old (Davis et al. 2000, Omid et al. 2008, Zamzam and Bakarman 2009). At this age, the potential for fracture remodeling decreases; therefore, malreduction may lead to persistent deformity (Wessel et al. 2003).In displaced fractures, the most common operative treatment is closed reduction and pin fixation. Different techniques have been reported, but crossed pinning with postoperative immobilization is the preferred technique (Brauer et al. 2007, Kocher et al. 2007, Zamzam and Bakarman 2009). Iatrogenic injury to the ulnar nerve has been described in up to 20% of the cases treated with crossed pinning (Lyons et al. 1998). In addition, radial pinning may damage the radial and anterior interosseous nerve (Brauer et al. 2007, Kocher et al. 2007, Omid et al. 2008).In 1990, a technique with antegrade nailing for supracondylar fractures was first described by Prevot et al. (1990). Schaffer et al. (2007) and Weinberg et al. (2003) treated 60 and 50 children with this technique and reported no iatrogenic injuries to the ulnar nerve.We determined the outcome and compared the rates of iatrogenic injuries to the ulnar nerve in a consecutive series of displaced supracondylar humeral fractures in children treated with either crossed pinning or antegrade nailing.     

Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D deficient patients: a randomized, double-blind, placebo-controlled pilot study

Introduction  

Vitamin D deficiency is encountered frequently in critically ill patients and might be harmful. Current nutrition guidelines recommend very low vitamin D doses. The objective of this trial was to evaluate the safety and efficacy of a single oral high-dose vitamin D3 supplementation in an intensive care setting over a one-week observation period.     

Simulation of a mycological KOH preparation – e‐learning as a practical dermatologic exercise in an undergraduate medical curriculum

Background: Mycological KOH preparation is one of the most popular practical laboratory skills in dermatology. The study addresses the question whether an interactive simulation program enhances knowledge of students about this procedure. Methods: 166 students, 107 female and 59 male, participated. We separated our study in three phases: pretest, completing the simulation three times and post‐test. In the pre‐ and post‐test we recorded the number of correct steps of the mycological KOH preparation listed by the students. The full text feedback was explored by content analysis. Results: In the pre‐test the students listed an average of 3.1 ± 2.2 correct steps, compared to 8.8 ± 1.2 correct steps after completing the simulation (p < 0.001). Furthermore, the improvement was significant for each individual step. There were no significant differences between male and female students. In content analysis of the feedback, positive statements prevailed with 78.3%, compared to only 1.8% critical items. Conclusion: Our study shows that an interactive computer simulation program of mycological KOH preparation results in a significant learning effectiveness as far as recall of the correct procedural steps is concerned. Furthermore, subjective acceptance by students is high.     

Multiple apocrine hidrocystomas on the eyelids

A 31-year-old man with multiple cystic tumors symmetrically distributed on his eyelids is presented. Histopathology and immunohistochemistry suggest the diagnosis of apocrine hidrocystomas. Apocrine hidrocystomas occur frequently on the face, but multiple and symmetrical occurrence on the eyelids has not been reported up to now.     

Intraoperative radiation therapy combined with external irradiation in nonresectable non-small-cell lung cancer: preliminary report

Twenty-one patients with nonresectable non-small-cell lung cancer (15 squamous-cell, 4 adeno, 2 large-cell; T1-T3, N0-N2, all M0) underwent lymph node dissection and intraoperative irradiation of the tumor (IORT) with doses between 10 and 20 Gy (energies: 7 to 20 MeV electron beam). Postoperatively, 46-56 Gy external beam irradiation (8 or 23 MeV photon beam) were delivered to the mediastinum and 46 Gy to the tumor bearing area. Fifteen patients were available for follow-up investigations. The CT-scan tumor volumetry 4 weeks postoperatively showed a significant overall decrease (Wilcoxon test: p less than 0.05) with eight minor responses (MR) (tumor regressions between 4 and 45%) and six partial responses (PR) (between 50 and 84%). One case was not evaluable. A second volumetry after external irradiation was done in 14 patients, 18 weeks after IORT, showing 3 complete responses, 10 partial responses (62 to 84%), and 1 minor response (28%). The recent volumetries (10 patients) between 4.5 and 16.5 months after IORT showed 7 complete responses and 3 partial responses (63 to 94%). One patient died from intrabronchial hemorrhage at 7 weeks. Three others died from unrelated causes, 6, 12 and 14 months, respectively, after IORT and in one further case the cause of death at 15 months was local tumor regrowth. Within the median time elapsed since IORT (12 months) only this one case of local regrowth and one further case of distant spread were observed.     

Fournier gangrene with involvement of the thigh--radical restoration by exarticulation of the femur. Case report

We report a case of Fournier's gangrene of the scrotum, involving the right lower extremity. Radical surgical intervention (hip joint exatriculation) was necessary.     

Students’ Inductive Reasoning Skills and the Relevance of Prior Knowledge: An Exploratory Study With a Computer-Based Training Course on the Topic of Acne Vulgaris

Background: The importance of inductive instruction in medical education is increasingly growing. Little is known about the relevance of prior knowledge regarding students’ inductive reasoning abilities. Purpose: The purpose is to evaluate this inductive teaching method as a means of fostering higher levels of learning and to explore how individual differences in prior knowledge (high [HPK] vs. low [LPK]) contribute to students’ inductive reasoning skills. Methods: Twenty-six LPK and 18 HPK students could train twice with an interactive computer-based training object to discover the underlying concept before doing the final comprehension check. Results: Students had a median of 76.9% of correct answers in the first, 90.9% in the second training, and answered 92% of the final assessment questions correctly. More important, 86% of all students succeeded with inductive learning, among them 83% of the HPK students and 89% of the LPK students. Conclusions: Prior knowledge did not predict performance on overall comprehension. This inductive instructional strategy fostered students’ deep approaches to learning in a time-effective way.     

Progress of medical students after open admission or admission based on knowledge tests

Medical Education 2010: 44 : 205–214 Context Although admission to university in Austria is generally open for applicants who have successfully completed secondary school, in some areas of study, including human medicine and dentistry, the selection of students by additional criteria has become legally possible as a result of a decision by the European Court in 2005. We studied the impact of this important change on the temporal pattern of medical students’ progress through the study programme. Methods All 2532 regular students admitted to the diploma programme in human medicine at the Medical University of Graz during the academic years 2002/03–2007/08 were included in the analysis. Non‐parametric and semi‐parametric survival analysis techniques were employed to compare the time required to complete the first two study semesters (first part of the curriculum) before and after the implementation of admission tests. Temporal patterns of dropout before this goal was achieved were also investigated. Sex, age and nationality of students were assessed as potential confounding variables. Results The cumulative probability of study success was dramatically better in selected students versus those who were admitted openly (P < 0.0001). Whereas only 20.1–26.4% of openly admitted students completed the first two study semesters within the scheduled time of 1 year, this percentage rose to 75.6–91.9% for those selected by admission tests. Similarly, the cumulative probability for dropping out of study was also significantly lower in selected students (P < 0.0001). By univariate as well as multivariate techniques, student nationality, age and sex were also identified as partly significant, albeit weak, predictors. Discussion The analysis convincingly demonstrates that, by contrast with open admission, performance‐based selection of medical students significantly raises the probability of successful study progress. Additionally, the proportion of dropouts is significantly reduced. Thus, admission tests save considerable costs, in terms of both student time and public resources.