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Biomedical subjects

L B Mellick

Publications and source records attributed to L B Mellick.

18 recordsLinked to original sources
PubMed1999

Neuromuscular blockade after ingestion of tree tobacco (Nicotiana glauca).

Two patients presented with life-threatening motor paresis after ingestion of leaves from the tree tobacco plant (Nicotiana glauca ). In addition to severe muscle weakness, bulbar palsies, flexor muscle spasm, hypertension, nausea, vomiting, and respiratory compromise were reported or observed. These are the fourth and fifth reported cases of a toxicologic emergency apparently caused by the alkaloid, anabasine, an isomer of nicotine found in the tobacco tree plant. The effects of this plant ingestion can mimic other better-known causes of paresis or paralysis. In areas of the country where the plant is indigenous, this toxicologic condition should be considered in the differential diagnosis of patients presenting with paresis or paralysis.

Adult↗
PubMed1999

Childhood accidental spiral tibial (CAST) fractures.

OBJECTIVE: To further define and describe the spectrum of presentations for accidental spiral tibial fractures of childhood. DESIGN: A retrospective review. METHODS: Children 8 years of age or younger who had sustained a tibial fracture within the last five or ten years were collected from the patient populations of two large tertiary medical centers in Southern California, Riverside General Hospital (RGH) and Loma Linda University Medical Center (LLUMC). A total of 189 tibial fractures were documented from both locations. Of the 189 patients, the 55 children with isolated spiral tibial fractures and no criteria for exclusion were selected for further review and analysis. These patients were reviewed for age at time of injury, gender, specific extremity involved, mechanism of injury, fracture location, degree of displacement, and whether child protective services involvement occurred. RESULTS: Patients with isolated spiral tibial fractures ranged in ages from 12 months to 94 months (7 years 10 months). The mean age was 50.7 months. Eighteen (32.7%) of the patients were less than or equal to 36 months of age. No patient was under one year of age. Males (38/55 or 69%) sustained the fracture slightly more frequently than females. The right extremity was injured slightly less frequently (45.5%) than the left extremity (54.5%). Overall, the lower two thirds of the tibia contained the fracture in 95% of the injuries. Displacement of the fracture segments was most frequently none or minimal. While Child Protective Service referrals or investigations were not accomplished on the majority of the children, no injury was confirmed to have occurred as a result of non-accidental trauma. CONCLUSION: Isolated spiral tibial fractures are a common injury of children less than 8 years of age and are most frequently accidental. The original description of a distinct clinical entity matching the original definition of the toddler's fracture does not appear to exist. Instead, the previously defined toddler's fracture is simply part of a spectrum of presentations of childhood accidental spiral tibial, or CAST, fractures. Consequently, our findings further support new nomenclature suggested for this fracture (1, 2).

Accidental Falls↗
PubMed1997

Reflex sympathetic dystrophy treated with gabapentin.

The use of the recently released anticonvulsant, gabapentin (Neurontin), in the treatment of severe and refractory reflex sympathetic dystrophy (RSD) pain in six patients ranging in age from 42 to 68 years is reported. Satisfactory pain relief obtained in all six patients suggests that this medication is an effective treatment for RSD pain. In addition to pain control, early evidence of disease reversal in these patients is suggested. Patient 6 is the first documented case of successful treatment and cure of the RSD pain syndrome using gabapentin alone. Specifically, reduced hyperpathia, allodynia, hyperalgesia, and early reversal of skin and soft tissue manifestations were noted. Gabapentin was chosen because it has properties similar to other anticonvulsant drugs and because previous studies have shown that it is well tolerated and appears to have a benign efficacy-to-toxicity ratio. It was considered an acceptable and compassionate therapeutic choice because previous medical and surgical approaches had been ineffective for these patients, who represent the first case series documenting the use of gabapentin for pain management. Presently, the mechanism of pain relief in these patients is unknown. In this article, the pathophysiology of RSD is discussed, and a mechanism by which gabapentin provides pain relief is proposed. In view of encouraging results in these and other RSD patients, further scientific investigation is needed to delineate the role of gabapentin in the treatment of reflex sympathetic dystrophy.

Acetates↗
PubMed1991

One size doesn't fit all. Choosing pediatric equipment: Part I.

Recent studies suggest that half the battle in treating pediatric patients is having access to the proper equipment. This article, the first in a two-part series, describes the factors to consider in selecting pediatric equipment for the prehospital setting.

Adolescent↗
PubMed1991

One size doesn't fit all. Choosing pediatric equipment: Part II.

This is the second in a two-part series designed to instruct EMS providers as to the benefits of procuring specially sized equipment for pediatric patients. This installment builds on the variables unique to this patient population and recommends specific types of pediatric equipment.

Child↗
PubMed1990

Spiral tibial fractures of children: a commonly accidental spiral long bone fracture.

Pediatric training in child abuse has consistently emphasized a strong association between nonaccidental injuries and spiral fractures of long bones. Isolated spiral tibial fractures of childhood have previously been recognized by the orthopedic specialty to most frequently be accidental in etiology. The authors present evidence that supports a predominantly accidental etiology for isolated spiral tibial fractures of young children. This article presents a series in which 9 of 10 such spiral fractures were most likely the result of an accident and not child abuse or gross neglect. Additionally, almost all of these fractures presented as a gait disturbance and should be included in the differential of this complaint.

Accidents, Home↗
PubMed1990

Sludge/sluice.

Explore the source record for details and available documents.

Abbreviations as Topic↗
PubMed1989

Presentations of acute phenytoin overdose.

A 15-year-old boy ingested 19.6 g (15 g verifiable) phenytoin sodium approximately four hours before emergency department presentation. The patient survived the suicide attempt with only supportive care, despite the ingestion of 392 mg/kg and a peak serum level of 100.8 micrograms/mL. A wide spectrum of physical findings consistent with acute massive ingestion of phenytoin was noted. This case report and a review of cases reported in the English literature of acute single anticonvulsant ingestion further delineate the clinical presentation of acute phenytoin overdose.

Adolescent↗
PubMed1988

Tibial fractures of young children.

Tibial fractures are relatively frequent injuries of young children. These fractures are occasionally the cause of a childhood gait disturbance. Additionally, tibial fractures may be the result of child abuse. Consequently, the pediatrician should have knowledge concerning these injuries. In this paper, we present a review of tibial fractures in hospitalized children and describe their associations with nonaccidental trauma (NAT). Finally, we provide suggestions for improving nonmenclature clarity for isolated spiral fractures of the tibia.

Accidental Falls↗
PubMed1986

Testicular torsion following orchiopexy.

A case of testicular torsion one year after orchiopexy is presented. The occurrence of testicular torsion following surgery is a rare event which has the potential for diagnostic misadventures. To better delineate this condition, we performed a literature review of all reported cases of recurrent testicular torsion. Thirteen reported patients with testicular torsion following orchiopexy are presented and discussed.

Adult↗