RESUMEN
Phaeochromocytoma is a catecholamine producing tumour and an uncommon cause of hypertension. We present two cases of relatively asymptomatic individuals, in which previously undiagnosed phaeochromocytoma was unmasked by elective nonadrenal surgical procedures, manifesting as postoperative hypertensive crisis and subsequent cardiogenic shock. The initial management in intensive care is discussed, in addition to the clinical and biochemical diagnostic challenges present. Successful adrenalectomy was performed in each case.
RESUMEN
We report the case of a patient who presented with coma in the context of baclofen and quetiapine overdose. While the clinical picture was largely in keeping with previous descriptions of baclofen and quetiapine toxicity, the patient went on to exhibit clinical and biochemical features of cranial diabetes insipidus, a finding which has not previously been described in this context.
Asunto(s)
Baclofeno/envenenamiento , Diabetes Insípida/inducido químicamente , Dibenzotiazepinas/envenenamiento , Sobredosis de Droga , Humanos , Masculino , Persona de Mediana Edad , Fumarato de QuetiapinaRESUMEN
Injuries in childhood represent a major public health concern. North and West Belfast is an area in which a high rate of emergency department attendance due to injury has been observed, and in which social deprivation is widespread. We carried out a cross sectional survey of 479 injuries in children aged 0-12 years presenting to four emergency departments serving North and West Belfast. Injury rates were compared between the most deprived and least deprived areas, selected on the basis of Noble Economic Deprivation scores. A significant correlation between economic deprivation and injury rate was demonstrated (r = 2.14, p < or = 0.001). Children living within the most deprived areas were particularly likely to be involved in road traffic accidents (relative risk RR = 3.25, p = 0.002). We conclude that children living within the most deprived areas of North and West Belfast are at greater risk of injury than those in less deprived areas. Specific causes of injury, for example burns and scalds, high falls, and motor vehicle accidents are particularly associated with deprivation. Targeting should be taken into account when injury prevention strategies are being developed.
Asunto(s)
Carencia Psicosocial , Heridas y Lesiones/epidemiología , Niño , Preescolar , Estudios Transversales , Servicio de Urgencia en Hospital , Humanos , Lactante , Recién Nacido , Irlanda/epidemiología , Medio Social , Factores SocioeconómicosRESUMEN
The CCR5 chemokine receptor has been implicated in the pathogenesis of multiple sclerosis (MS). We carried out an allelic association study using a deletion polymorphism in the coding region of the CCR5 gene in 331 relapsing-remitting (RR) and secondary progressive (SP) MS patients, 108 primary progressive (PP) MS patients and 230 healthy controls. Of the 331 RR and SPMS patients, 172 were recruited from specialist clinics and 159 from a population survey. Disease severity was assessed clinically using the Expanded Disability Status Scale (EDSS) and used to calculate a progression index for each patient (defined as EDSS divided by duration of disease). No significant difference in distribution of the CCR5 delta32 allele was observed between the 331 RR/SPMS patients and controls, between the 108 PPMS patients and controls or between the PPMS and RR/SPMS groups. Furthermore, no differences in rate of disease progression were detected between carriers and noncarriers of the delta32 allele. In the population-based group of RR/SPMS patients, carriage of the CCR5 delta32 polymorphism was associated with a lower age at disease onset (mean age 26.562 versus 31.065 years, P = 0.003). However, no significant differences in age of onset were present in the PPMS group or in a second RRMS population. These results suggest that the CCR5 delta32 polymorphism is not a major determinant of susceptibility to develop MS in the population under study, and conflict with a previously reported association between CCR5 delta32 carriage and a better prognosis.