Use of esmolol to control autonomic instability of tetanus
Article Abstract:
Tetanus, a condition caused by a microorganism that leads to permanent contraction of the muscles and, often, death, is an uncommon condition in the US, but an important disease worldwide. As many as 21 percent of the people who develop tetanus die, with fatality rates higher among the elderly, the drug-addicted, and the severely ill. Autonomic instability is usually the immediate cause of death: in this complication, blood pressure, heart rate and rhythm, body temperature, and other autonomic functions become wildly deranged. The case report is presented of a 42-year-old woman who developed neck pain and difficulty opening her mouth. She then began to have trouble breathing and required insertion of a tube into the airway. The patient had a history of intravenous drug abuse and subcutaneous injections. Her blood pressure was elevated, the heart rate was extremely fast, and edema (swelling of the extremities) was noted. Severe tetanus was diagnosed and treatment with tetanus immune globulin, tetanus toxoid, and penicillin was instituted. After nine days, the administration of esmolol, a beta-blocker, was begun. The drug was stopped for several days, then started again when propranolol was ineffective in controlling the patient's blood pressure. The patient improved, and esmolol was discontinued after 63 days in the hospital. She was transferred to rehabilitation medicine on day 87 and was discharged after 144 days. A discussion is presented of the complications of tetanus that occur in the autonomic nervous system, and of their treatment with beta- and alpha-blockers (drugs that block the action of epinephrine and norepinephrine) and other drugs. Esmolol offered several therapeutic advantages; while its cost ($450 each day, for a total 44-day treatment cost of $20,000) was high, this represented only a small proportion of the charges for the patient's overall medical care. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Concave carving point
Article Abstract:
Diamond carving tools usually cut a concave surface, and not a uniform convex curve over surfaces of diminishing sizes. A personal narrative on the creation of a unique tool in carving gemstones to create a convex curved surface is given. Concave carving points plated in 120 and 600 grit diamond with a 3mm and 6mm radius were made and tested.
Publication Name: Lapidary Journal Jewelry Artist
Subject: Hobbies and crafts
ISSN: 1936-5942
Year: 2008
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Can the Eye be copied?
Article Abstract:
There are concerns over the copyright issues if the Building Design Partnership's designs of a large ferris wheel for Prague, Czech Republic, have any similarity to the design of the London Eye.
Publication Name: Building
Subject: Construction and materials industries
ISSN: 0007-3318
Year: 2000
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