Saturday, 16 October 2010

Terminal Burrowing (Hide-and-Die Syndrome)


Terminal burrowing details:
  • Alternative name - hide-and-die syndrome.
  • Behavioural pattern observed in the last stages of hypothermia.
  • The individual enters small, enclosed spaces, ie cupboards, closets, wardrobes.
  • In outdoor situations the victim may hide themselves in culverts, crevices between rocks or felled trees or even burrow under leaves.
Precipitating situations:
  • Most often observed in moderately cold conditions.
  • The individual's body temperature generally has fallen slowly.
  • With dwelling associated episodes the condition is found during power outages.
  • Outdoor episodes occur when the person is lost in chilly, but not freezing, weather.

Image: Burrowing Owl from TinyPic.com
Tags:
Cold - Hypothermia - Hide-and-die Syndrome - Terminal Burrowing
Posted by Medicalchemy
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Tuesday, 12 October 2010

Paradoxical Undressing (Hypothermia Complication)


General Features:
  • The inappropriate removal of clothing with an associated hypothermia.
Clinical Features:
  • Typically occurs during moderate to severe hypothermia.
  • Occurs as the person becomes disoriented, confused & combative.
  • Removal of clothing increases the rate of heat loss.
Epidemiology:
  • Associated with 20% - 50% of hypothermia deaths.
Pathophysiology:
  • Possibly caused by cold-induced malfunction of the hypothalamus.
  • Other contributors may be peripheral vascular smooth muscle fatigue leading to paradoxical vasodilatation & a feeling of warmth from the surge of warmer central blood to the extremities.
  • This vasodilalation may fool the person into feeling hot.
  • Removal of clothing increases the rate of heat loss.
Public Health Issues:
  • Recognised issue in mountain rescue & survival training.
  • May be misinterpreted as evidence of a sexual assault in urban victims.

Image: from Ger Meinema (cc)
Tags:
Cold - Hypothalamus - Hypothermia - Paradoxial Undressing - Vasodilalation
Posted by Medicalchemy
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Friday, 15 May 2009

Recovery From Alcohol-related Brain Damage is Impaired by Smoking



Alcohol-use in excess is well known to cause damage to the brain. This damage may be particularly prominent in the frontal and parietal cortices. A recent study by Mon et al, using longtitudinal MRI imaging of brain blood flow, shows that smoking makes it more difficult for brain blood flow to recover following heavy drinking.

Reference:
Mon, A; Durazzo T.C; Gazdzinski, S; Meyerhoff, DJ.
The Impact of Chronic Cigarette Smoking on Recovery From Cortical Gray Matter Perfusion Deficits in Alcohol Dependence: Longitudinal Arterial Spin Labeling MRI.
Alcoholism Clinical and Experimental Research
, 2009
DOI: 10.1111/j.1530-0277.2009.00960.x

Tags: Alchohol - Alcohol Dependence - Brain - Brain Damage - MRI - Smoking
Posted by Medicalchemy
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Aspirin Prevention of Cardiovascular Events in Patients With Peripheral Artery Disease [Meta-analysis]



In patients with peripheral artery disease (PAD), aspirin significantly reduces the risk of non-fatal stroke according to a new meta-analysis. The JAMA study by Jeffrey S. Berger et al of the University of Pennsylvania, Philadelphia is entitled - Aspirin for the Prevention of Cardiovascular Events in Patients With Peripheral Artery Disease: A Meta-analysis of Randomized Trials.

Key points of the study were:
  • Meta-analysis of 18 trials, which including 5,269 patients; 2,823 were randomized to aspirin therapy (and of these, 1,516 received aspirin monotherapy) and 2,446 were randomized to placebo / control.
  • A total of 251 (8.9%) cardiovascular events occurred among patients receiving any aspirin therapy compared with 269 (11.0%) events among the control patients.
  • The calculated 12 % reduction in cardiovascular event rates was not statistically significant.
  • The risk of nonfatal stroke was significantly lower (34%) in the aspirin group than in the placebo group (event rates of 1.8% vrs. 3.1%)
  • There was no significant reductions in all-cause mortality, or cardiovascular death, heart attack, or major bleeding in patients receiving any aspirin therapy.
  • 125 cardiovascular events occurred among 1,516 patients (8.2%) receiving aspirin monotherapy 144 events among 1,503 patients (9.6%) in the placebo / control groups.
  • Aspirin monotherapy was associated with a 36% reduction in the risk of nonfatal stroke (2.1% vrs. 3.4%).
  • There was no significant reductions in all-cause mortality, or cardiovascular death, heart attack, or major bleeding in patients receiving aspirin monotherapy.
Reference:
Berger et al.
Aspirin for the Prevention of Cardiovascular Events in Patients With Peripheral Artery Disease: A Meta-analysis of Randomized Trials.
JAMA The Journal of the American Medical Association, 2009; 301 (18): 1909
DOI: 10.1001/jama.2009.623

Tags: Aspirin - Berger - Cardiovascular Events - Stroke - Peripheral Artery Disease
Posted by Medicalchemy
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