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PubMed2000

Fracture of the penis: treatment and complications.

Fracture of the penis is an unusual blunt traumatic injury of the erect penis. Twenty-five such cases, treated at the 2 main urological departments in the town of Varna between 1984 and 1999, were analyzed retrospectively. The average annual incidence in this series was 0.33 per 100,000 inhabitants. Most of the injuries occurred during vigorous sexual intercourse. Clinical diagnosis was mainly based on the patient's history and the physical findings. The diagnosis was verified by ultrasonography. In a few cases retrograde urethrography and cavernosography were used as additional diagnostic tools. Cavernosography was complicated by postprocedural priapism in 1 case. Unilateral tear of the corpora cavernosa was found in 24 cases. In 3 cases, partial (in 2) or complete (in 1) disruption of the corpus spongiosum and the urethra was found as well. The trauma was bilateral in 1 case in which 2/3 of the entire circumference of the penis was ruptured, including both corpora cavernosa and the urethra. Seventeen patients received immediate surgical repair. Most of them experienced an uneventful postoperative period with no serious consequences affecting their sexual function. Surgery was delayed in 6 and rejected in 2 cases. In all cases in which conservative (nonsurgical) management was the first treatment option, late complications (penile aneurysm, induration, penile curvature, erectile dysfunction) were observed and the final results were assessed as satisfactory or poor. We recommend immediate surgical treatment of all cases of penile fracture. Emergency surgical repair offers a chance for complete recovery and is the best method for providing a good functional prognosis.

Humans↗
PubMed1994

Adverse effects of alpha 1-adrenergic blocking drugs.

Earlier nonselective alpha 1-adrenergic blocking drugs such as phentolamine and phenoxybenzamine are now restricted to the pharmacological management of alpha 1-adrenergic crisis and phaeochromocytoma. Prazosin, the first selective alpha 1-blocker approved for the treatment of hypertension, became available in the mid-1970s. Additional alpha 1-blockers such as doxazosin and terazosin have been introduced during recent years. The undesirable effects of all members of this class are similar. Most adverse events can be attributed to reversible competitive antagonism of postsynaptic alpha 1-adrenergic receptors in tissues that sustain high levels of alpha-adrenergic sympathetic tone, e.g. resistance arteries, capacitance veins and the urinary bladder outflow tract. Orthostatic hypotension with a sensation of intense faintness and occasional syncope, can occur shortly after the initial dose. Aggravating factors include upright posture, intravascular volume depletion and concurrent administration of other medications that lower blood pressure, including all other classes of antihypertensive drugs. The problem is reduced or avoided by the choice of low starting doses, beginning treatment at bedtime and by minimising other risks. Among overall adverse effects, asthenia, dizziness, faintness and syncope predominate and occur in 10 to 20% of patients, leading to discontinuation of therapy in about half that number. Infrequent adverse events include headache, drowsiness, palpitations, urinary incontinence and priapism. Some patients experience a 1 to 2kg bodyweight gain which may be associated with secondary hyperaldosteronism. Tolerance appears to develop to the benefits of alpha 1-blockade in patients with congestive heart failure, but not in hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Antagonists↗
PubMed1998

Psychotropic drug-induced sexual function disorders: diagnosis, incidence and management.

The human sexual response can be divided into 3 phases: desire (libido), excitement (arousal) and orgasm. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classifies sexual disorders into 4 categories: (i) primary; (ii) general medical condition-related; (iii) substance-induced; and (iv) 'not otherwise specified' sexual dysfunctions. Each of the 4 DSM-IV categories has disorders in all 3 sexual phases. Substance-induced sexual dysfunctions are caused by the use of either substances of abuse [alcohol (ethanol), amphetamines, cocaine, opioids or sedatives/hypnotics/anxiolytics], or prescription medications which include psychotropic drugs. Patients with psychiatric difficulties tend to experience more frequent sexual function disturbances. The literature provides more than anecdotal evidence that psychotropic drugs can induce sexual function disorders in the epidemiologically vulnerable population of psychiatric patients. Sexual dysfunctions caused by psychotropic drugs can be divided into 2 groups: sexual inhibition (inhibited desire, inhibited arousal and inhibited orgasm) and increased sexual function disorders (increased sexual desire, priapism and premature ejaculation). The diagnosis of psychotropic drug-induced sexual function disorders is easy if the psychiatrist is sensitive to the existence of these adverse effects. This mostly involves careful history taking, although several questionnaires have been developed for reliable and valid quantification of sexual functioning. Diagnosis is usually established if the sexual function disorders develop when the patient is receiving a psychotropic drug and then disappear when the offending drug is discontinued. The management of psychotropic-drug induced sexual inhibition can be divided into 6 steps: inform the patient about the possibility of sexual inhibition occurring before prescribing a psychotropic agent; wait for remission or tolerance of sexual inhibition; reduce the dosage of the psychotropic drug; switch the medication to one less likely to cause sexual inhibition; if possible, adjust the concomitant nonpsychotropic drugs; and add various pharmacological agents to the existing psychotropic drug to treat the sexual inhibition. Physicians should take sexual histories as a routine practice when prescribing psychotropic drugs. Through careful management and patience on the part of both the patient and the physician, psychotropic drug-induced sexual function disorders can be improved so that the patient's compliance with medication and quality of life can be optimised.

Female↗
PubMed1999

Comparative tolerability and efficacy of treatments for impotence.

Modern pharmacological treatment of impotence is determined by the presenting symptoms. Since this involves symptomatology with a heterogenous aetiology, many different drugs are involved in the treatment of impotence. Drugs used for libido and arousal problems include testosterone, yohimbine, trazodone and apomorphine. Since patient self-assessment is the only parameter that can be used to measure the result of treatment and positive results are seldom affirmed, no positive benefit of these agents can be assumed at present. Oral medications for erectile dysfunction include yohimbine, trazodone, apomorphine, phentolamine, arginine and sildenafil. Of these drugs, sildenafil has been the most systematically studied for effectiveness, but long term safety data await the results of post-marketing surveillance. Of the ejaculation disorder therapies, treatments for premature ejaculation are the best studied. Favourable results have been obtained with clomipramine, paroxetine and fluoxetine. The safety of these medications has been assessed through their long term use in psychiatry. Intracavernous self-injections for erectile disorders are performed using a variety of drugs and drug mixtures. Only alprostadil and the combination of papaverine with phentolamine are widely used. Alprostadil is very well tolerated; however, penile pain is a serious problem in a significant proportion of patients. Papaverine in combination with phentolamine is effective, but penile fibrosis and priapism occur more often than with the use of alprostadil. Several new developments in this area are currently under way. Alternative routes for medication for erectile dysfunction include ointments and patches to the penile skin and the glans. Only transurethral alprostadil, 'MUSE' (medicated urethral system for erection) has been shown to be effective in large trials. Long term safety still has to be demonstrated, but the 1-year safety profile is encouraging. In general, the end points of impotence treatment studies are very diverse so efficacy data can only be assessed in comparative studies. However, long term comparison studies have not been performed. Safety demands must be set very high for this type of treatment since the disorders being treated present no threat to the patient's health.

Aphrodisiacs↗
PubMed1994

Trazodone. A review of its pharmacology, therapeutic use in depression and therapeutic potential in other disorders.

Trazodone is a triazolopyridine derivative, chemically and pharmacologically unrelated to other currently available antidepressants. It possesses antidepressant, and also some anxiolytic and hypnotic activity. Results from a small number of short term (4 to 6 weeks) comparative studies in a total of 320 evaluable elderly patients with major depression, suggest that trazodone at therapeutic doses is superior to placebo and as effective as amitriptyline, imipramine, fluoxetine and mianserin in relieving depressive symptoms. Trazodone has also been successfully used in a small number of patients with depression and pre-existing cardiovascular disease. More recently, trazodone has been used as a hypnotic for psychotropic-induced or other insomnias with some success. However, further clinical experience is needed to confirm these preliminary results. In the elderly, maximum tolerated doses of trazodone are 300 to 400 mg/day, although higher doses of up to 600 mg/day are tolerated by younger patients. Drowsiness is commonly reported, but the incidences of both anticholinergic and cardiovascular effects were notably lower in elderly patients treated with trazodone compared with older tricyclic antidepressants. However, undesirable effects such as orthostatic hypotension, arrhythmias and priapism need to be closely monitored. In comparison with other currently available agents, particularly the tricyclic antidepressants, trazodone is relatively safe in overdose. In terms of therapeutic efficacy, trazodone appears to confer little advantage over other available antidepressants. While limited data suggest that trazodone may be better tolerated than older tricyclic antidepressants, especially in the elderly, there is a paucity of data at present comparing trazodone with the secondary amine tricyclic agents, serotonin reuptake inhibitors or moclobemide. Bearing this in mind, trazodone may be of use in elderly patients in whom anxiety and insomnia are problematic, and in those patients who are unresponsive to or cannot tolerate therapy with other agents. Studies are also required to define the place of trazodone in long term prophylactic therapy for recurrent depression. Future trials comparing both its efficacy and tolerability with those of newer agents will ascertain whether trazodone becomes a first line agent within these subsets of elderly patients.

Aged↗
PubMed1996

Intracavernous alprostadil. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic potential in erectile dysfunction.

Intracavernous alprostadil (synthetic prostaglandin E1) is a vasodilating agent which acts by relaxing the smooth muscles of the corpus cavernosum and by increasing the diameter of cavernous arteries; this leads to erection. Following intracavernous administration, alprostadil is either locally metabolised or rapidly cleared from the penis into the systemic circulation where it is extensively metabolised by the lungs. Studies suggest that long term use of intracavernous alprostadil may increase penile blood flow, although the clinical relevance of this is not currently known. In men with erectile dysfunction (ED), short term trials have shown that intracavernous alprostadil is superior or equal, in inducing erections, to other intracavernous agents such as papaverine, the combination of papaverine plus phentolamine, linsidomine and topical nitroglycerin (glyceryl trinitrate). Intracavernous alprostadil induced erections in around 70% of patients with ED of various origins in short term studies. 49 to 84% of patients accept the offer of joining self-injection programmes and 13 to 60% of these patients withdraw from such programmes for a variety of reasons. At therapeutic doses, intracavernous alprostadil is well tolerated. The most common adverse event of transient penile pain occurred in around one-third of patients and in 11% of injections, causing 3 to 5% of patients to withdraw from self-injection programmes. Potentially serious adverse events such as priapism and fibrosis occurred in 4 and 8% of patients. Overall, available data suggest that the efficacy of intracavernous alprostadil is superior or equal to that of other erectogenic agents which are in use. Furthermore, the drug is well tolerated especially with regard to serious adverse events. Thus, although further research is necessary to confirm its use in combination with other agents, alprostadil appears likely to become the intracavernous agent of choice for the management of erectile dysfunction.

Alprostadil↗
PubMed1990

Self-administration in the pharmacological treatment of impotence.

Recent innovative research into the physiology and pharmacology of erection and the introduction of intracavernous injection of vasoactive agents have revolutionised our approach to the diagnosis and treatment of impotence. A thorough understanding of the rationale, indications, precautions and potential complications of intracavernous self-injection is essential for successful management. The commonly used drugs for injection are papaverine, either alone or in combination with phentolamine, and alprostadil (prostaglandin E1). The major adverse effects include priapism, prolonged erection, and fibrosis of the erectile tissue. With the proper technique and appropriate dosage, this is a safe, minimally invasive, and highly effective treatment.

Animals↗
PubMed1995

Pharmacological management of erectile dysfunction.

Pharmacological treatment of erectile dysfunction includes all therapeutic modalities based on the use of erectogenic drugs, regardless of the route of administration. Intracavernous vasoactive injection therapy is the most commonly used treatment for erectile dysfunction. Most patients respond to intracavernous injection of either single or multiple vasoactive drugs. Major adverse effects related to this treatment include priapism, corporeal pain and the formation of nodules or plaques in the corpora cavernosa. Oral administration of drugs aimed at improving erectile function has not produced results comparable with those obtained with intracavernous injection therapy. However, in patients with psychogenic or mild organic impotence, oral treatment with drugs that influence either central or peripheral pathways controlling erection may improve erectile function. Topical administration of vasoactive drugs in the form of gels, liquid solutions or plasters is another attractive alternative for the treatment of psychogenic and mild organic erectile dysfunction. Although the ideal drug for the treatment of erectile dysfunction has not yet been identified, extensive laboratory and clinical research is ongoing and successful results are expected in the near future.

Administration, Oral↗
PubMed1997

Defibrinogenating enzymes.

The venoms from 3 snakes have been shown to induce defibrinogenation: ancrod from the venom of Calloselasma rhodostoma (formerly known as Agkistrodon rhodostoma), batroxobin from the venom of Bothrops atrox moojeni, and crotalase from the venom of Crotalus adamanteus. The purified fractions of ancrod, batroxobin, and crotalase possess coagulant, proteolytic and esterolytic properties, although their primary mechanism of action is a proteolytic effect on circulating fibrinogen. Ancrod cleaves only the A-fibrinopeptides, but not the B-fibrinopeptides, from fibrinogen; this contrasts with thrombin, batroxobin and crotalase, which cleave both fibrinopeptides A and B. Within minutes of administration of ancrod or batroxobin, there is a significant reduction in plasma fibrinogen levels, and these remain exceedingly low with repeated administration (once or twice daily). The rapid fall in plasma fibrinogen levels is accompanied by a slightly delayed but marked rise in the level of fibrinogen-fibrin degradation products. Plasminogen levels are decreased and blood viscosity is reduced, but formed elements in the circulating blood remain unaltered. Ancrod and batroxobin have been investigated in patients with stroke, deep-vein thrombosis, myocardial infarction, peripheral arterial thrombosis, priapism, and sickle-cell crisis; crotalase has not been administered to humans. However, results have been difficult to interpret, and additional well designed trials are needed to better define the optimum role of ancrod and batroxobin in the management of these conditions. Overall, treatment is well tolerated and serious adverse events are infrequent. In the coagulation laboratory, ancrod, batroxobin and crotalase may be used as reagents to perform coagulation studies on specimens of blood that contain heparin. These venom fractions can be substituted for thrombin in performing the thrombin time and in removing fibrinogen from plasma for accurate determination of fibrinogen-fibrin degradation products.

Ancrod↗
PubMed1997

Nefazodone. A review of its pharmacology and clinical efficacy in the management of major depression.

Nefazodone hydrochloride is a phenylpiperazine antidepressant with a mechanism of action that is distinct from those of other currently available drugs. It potently and selectively blocks postsynaptic serotonin (5-hydroxytryptamine; 5-HT) 5-HT2A receptors and moderately inhibits serotonin and noradrenaline (norepinephrine) reuptake. In short term clinical trials of 6 or 8 weeks' duration, nefazodone produced clinical improvements that were significantly greater than those with placebo and similar to those achieved with imipramine, and the selective serotonin reuptake inhibitors (SSRIs) fluoxetine, paroxetine and sertraline. The optimum therapeutic dosage of nefazodone appears to be between 300 and 600 mg/day. Limited long term data suggest that nefazodone is effective in preventing relapse of depression in patients treated for up to 1 year. Analyses of pooled clinical trial results indicate that nefazodone and imipramine produces similar and significant improvements on anxiety- and agitation-related rating scales compared with placebo in patients with major depression. Short term tolerability data indicate that nefazodone has a lower incidence of adverse anticholinergic, antihistaminergic and adrenergic effects than imipramine. Compared with SSRIs, nefazodone causes fewer activating symptoms, adverse gastrointestinal effects (nausea, diarrhoea, anorexia) and adverse effects on sexual function, but is associated with more dizziness, dry mouth, constipation, visual disturbances and confusion. Available data also suggest that nefazodone is not associated with abnormal weight gain, seizures, priapism or significant sleep disruption, and appears to be relatively safe in overdosage. Nefazodone inhibits the cytochrome P450 3A4 isoenzyme and thus has the potential to interact with a number of drugs. Further long term and comparative studies will provide a more accurate assessment of the relative place of nefazodone in the management of major depression. Nonetheless, available data suggest that nefazodone is a worthwhile treatment alternative to tricyclic antidepressants and SSRIs in patients with major depression.

Animals↗
PubMed1988

Pharmacologically induced erection in patients with multiple sclerosis.

Intracavernous injection of papaverine was tested in a group of 29 patients with multiple sclerosis and erectile dysfunction. Acceptable rigidity was obtained in 27 patients of whom 23 started to use self-injections as treatment. During an observation period of 5-12 months (mean 8.5 months) a total of 297 injections (3-35 per patient) were reported and 272 injections (92%) produced rigidity in 8-480 min. One case of priapism was seen. Minor haematomas or ecchymoses were reported in 16 cases. Two patients developed penile indurations after 6 and 19 injections respectively; one of these indurations resolved spontaneously. Self-injection with papaverine was found to be a safe and well-accepted treatment of erectile dysfunction in multiple sclerosis but long term side effects need further elucidation before the treatment is to be used as a routine procedure.

Adult↗
PubMed1997

Strangulation of the scrotum.

A man presented to our department showed scrotal swelling and beginning priapism due to a ball bearing ring. The patient had passed his scrotum through the metal ring eight years before. Now he has observed an increasing swelling for seven days. The condition had to be treated operatively.

Constriction, Pathologic↗
PubMedDate not supplied

[Penile necrosis: a review of 18 cases at the Hospital de Especialidades Centro Médico nacional Siglo XXI].

OBJECTIVES: To report the experience in the management of penile necrosis at our hospital. METHODS: We performed a review of the medical records with the diagnosis of penile necrosis at the Department of the Urology of the Hospital de Especialidades Centro Médico nacional Siglo XXI from January 1995 to March 2005. RESULTS: 18 cases of penile necrosis were found, with ages from 28 to 78 years (mean age 58.1 yr.). Diabetes mellitus and end stage renal disease were the most frequent associated diseases, with 10 and 11 cases respectively. Reasons for consultation were penile scars in 5 cases, purulent exudation, inflammation of the glans penis and prepuce in 3, ischemic priapism in 2, Fournier's syndrome in 2, urethral bleeding in one, penile necrosis secondary to extrinsic compression in one, and periurethral abscess in another. Thirteen out of the 18 cases underwent partial or complete penectomy, and three of them died. Five patients were managed conservatively with antibiotics, one of them died. The pathology report showed ischemic necrosis in 3 cases, arterial and venous thrombosis, ischemic necrosis and dystrophic arterial and venous calcifications in 10 cases. CONCLUSIONS: Occlusive vascular changes are a conditioning factor in most patients with penile necrosis. This is more evident in patients with end stage renal disease, diabetes mellitus and hypertension. Clinical features of penile necrosis include scars, mummification, self-amputation, and superinfection, so that an early diagnosis and proper treatment are decisive for the evolution of this disease.

Adult↗
PubMed1983

Clomiphene-responsive hypogonadism in sickle cell anemia.

Two 19-year-old men with sickle cell anemia and hypogonadism had hypothalamic dysfunction that responded to oral clomiphene therapy. The patients had no nutritional deficiencies or anatomic lesions known to result in the hypogonadism associated with sickle cell anemia. Their sickle cell disease was characterized by infrequent crises, severe hemolytic anemia, urinary iron loss, and iron deficiency. Partial hypothalamic hypogonadism was shown by low levels of testosterone, low to low-normal levels of luteinizing hormone and follicle-stimulating hormone, and a nearly normal rise in gonadotropin levels in response to exogenous gonadotropin releasing hormone. Treatment with oral clomiphene raised luteinizing hormone, follicle-stimulating hormone, and testosterone levels to normal, and induced puberty in both patients. Treatment was discontinued in one patient because of the onset of priapism, but was continued for 10 months without side effects in the other. Severe hypogonadism in patients with sickle cell anemia should be thoroughly evaluated and clomiphene therapy considered in patients with hypothalamic dysfunction.

Adult↗
PubMed1996

[The use of PGE1 in the treatment of erectile deficiency].

A total of 118 patients entered into a pharmacological erection program using prostaglandin E1 (PGE1) from September 1994 to November 1995. Of the men 20 (16.9%) used PGE1 on a regular basis, median duration of drug use was 4 months with a range of 2 to 14 months, while 66 (55.9%) failed to continue in the program after the dose titration period, (median duration of drug use 6 weeks), 32 (27.1%) failed to initiate PGE1 pharmacological erection program. There have been no instances of cavernous fibrosis, systemic reaction, penile pain after injection or priapism (erection present longer than 4 hours) in any patient; 24 (20.3%) men were unable to achieve an adequate erection with PGE1 intracavernous injections. PGE1 appears to have a lower risk of prolonged erections than other intracavernous agents and will continue to increase in popularity. However we report an interesting number of men who fail to continue (55.9%) or fail to initiate (16.9%) PGE1 therapy.

Alprostadil↗
PubMed1999

[Management of adults with sickle cell anemia].

The management of adults with sickle cell disease should be geared to the profile of the disease in adulthood. The chronic hemolytic anemia impacts everyday activities. Paroxysmal complications include painful vasoocclusive crises, acute chest syndrome, priapism, and infections. Potentially life-threatening chronic complications should be detected and treated early; they include cardiopulmonary, renal, and hepatic involvement. Osteonecrosis of the hip can result in functional impairment. Pregnancy and anesthesia require special precautions. A multifaceted personalized management program, if possible at a sickle cell disease center working closely with other health care providers and social workers, offers the best hope for providing ever-increasing gains in quality of life for sickle cell disease patients.

Adult↗
PubMed1999

Oral trazodone is not effective therapy for erectile dysfunction: a double-blind, placebo controlled trial.

PURPOSE: The unusual side effect of priapism associated with the antidepressant trazodone has led researchers to evaluate its use for the treatment of erectile dysfunction. Previous studies have shown nearly 70% efficacy in patients. Unfortunately, these studies have been anecdotal, retrospective or of combination therapy with yohimbine. A placebo controlled, fixed dose, double-blind crossover study was performed to evaluate the safety and efficacy of oral trazodone for the treatment of erectile dysfunction. MATERIALS AND METHODS: A total of 51 patients with at least 3 months of complete erectile dysfunction were randomized in a double-blind fashion to receive 50 mg. trazodone or placebo at bedtime. Evaluation consisted of a history, physical examination and laboratory studies, including hormonal evaluation, nocturnal penile tumescence evaluation, penile Doppler ultrasound and the Index of Sexual Satisfaction. Patients were followed at monthly intervals with an in clinic interview. After a 3-month treatment interval patients were reevaluated with index scores and crossed over after a 3-week washout period. Study end points included patient diary evaluations and index scores at the beginning of the study interval and the end of the first treatment period. RESULTS: Of the 51 patients who enrolled in the study 48 completed both phases. Mean patient age was 65 years (range 31 to 80). After the first 3-month treatment interval 19% of patients receiving trazodone had improved erections compared to 24% receiving placebo (p < 0.50). Of the trazodone group 35% had improvement in sex drive compared to 20% of the placebo group (p < 0.36). Mean Index of Sexual Satisfaction scores changed after treatment from 31.7 to 27.5 for the trazodone group (p < 0.50) and from 28.5 to 30.8 for the placebo group (p < 0.49). Side effects included drowsiness in 31% of the patients, dry mouth in 1% and fatigue in 19%. CONCLUSIONS: Trazodone is no more effective than placebo in improving erections and sexual function in patients with severe physiological erectile dysfunction.

Administration, Oral↗
PubMed1998

Clinical manifestations and management of scorpion envenomation.

The most venomous scorpion species are Buthotus tamulus of India, the Leiurus quinquestriatus and Androctonus crassicauda of North Africa and the Middle East, the Tityus serrulatus of Brazil, and the Centruroides suffussus of Mexico. The severity of scorpion envenomation varies with the scorpion's species, age, and size, and is much greater in children. Systemic intoxication reflects the overstimulation of the CNS, the sympathetic and parasympathetic nervous system. Severity ranges from local pain and paresthesia to fatal cardiotoxicity and encephalopathy. Symptoms include: agitation, tachycardia, vomiting, abdominal pain, salivation, diaphoresis, dehydration, muscle rigidity and twitching, tremor, seizures, coma, pupillary changes, hyperthermia, tachyarrythmias and occasionally bradyarrhythmias, hypertension, and less often hypotension, cardiac failure, and priapism in males. Laboratory abnormalities include: hyperglycemia, leucocytosis, transient elevation of cardiac and pancreatic enzymes, ischemic changes in the ECG, and evidence of cardiac dysfunction on echocardiography. The principles of management are: observation, cardiac monitoring, supportive treatment with intravenous fluids and electrolytes, and a meticulous use of cardiovascular agents: vasodilators, adrenergic antagonists, or calcium channel blockers in the hypertensive phase; and inotropic agents in the event of hypotension. Antiarrhythmics such as lidocaine, may be required. There is increasing evidence for the efficacy of specific antivenom. The advance in supportive care and antivenom efficacy has markedly improved the outcome of patients with scorpion envenomation.

Animals↗