Rarely Seen Compartment Syndrome of the Shoulder and Back: Diagnosis and Management

Compartment syndrome (CS) is a well-known surgical emergency with high morbidity including potential long-term disability and limb loss. The most important factor determining the degree of morbidity with CS is time to treatment; therefore, early diagnosis and surgery are vital. We present a patient who fell off his bicycle and sustained cervical spine fractures causing near complete quadriplegia. He was found by the road over 12 hours later, so his creatine phosphokinase (CPK) was trended and serial examinations were performed. We identified tight deltoid, trapezius, and latissimus compartments and brought him to the operating room for fasciotomies. Although lab values and compartment pressures can be helpful, they should not guide treatment. It is important to consider atypical sites for CS and complete a head to toe physical examination. Patients should proceed to the operating room if clinical suspicion exists for CS because of the morbidity associated with a missed diagnosis.

Death After Poison Ivy Smoke Inhalation

ABSTRACT

Urushiol, the active antigen in poison ivy ( Toxicodendron radicans ), is frequently associated with type I and type III hypersensitivity reactions. These reactions most often result in cutaneous symptoms that vary in severity and may at times require medical interventions. Injuries involving other body systems associated with urushiol exposure are far less common. Here, we present 2 unrelated cases of urushiol respiratory exposure status after burning of poison ivy that resulted in cardiopulmonary arrest and ultimately death. In both cases, the history, circumstances, and autopsy findings are consistent with urushiol smoke inhalation having either caused or contributed to death. The cases are unique in that they represent the first cases of death related to poison ivy smoke exposure. Clinicians and forensic pathologists should be aware of the fact that urushiol smoke exposure may lead to morbidity and mortality.

Train-related suicidal decapitation

Suicide by decapitation as a primary method of injury is not common. When decapitation does occur in association with suicide, it may be a secondary consequence of the primary method of suicide, for example massive blunt force trauma, or hanging with a significant drop; however, primary suicidal decapitation has been described specifically in the context of railway incidents wherein victims lie across railroad tracks in-front of oncoming trains. Herein we report the case of a 49-year-old male who was decapitated after lying-down with his neck atop a railroad track in a railroad stockyard. He was subsequently run over by a train as it began to move to leave the stockyard. This case of train-assisted suicide occurs less often than the more common modality of suicide by train wherein victims stand or jump in front of a moving train or lay their body across the railroad tracks in order to be struck by an oncoming train.

Microbeam laser-injured neurons increase in vitro astrocytic gap junctional communication as measured by fluorescence recovery after laser photobleaching

An important aspect of the neuronal-astrocyte relationship is the interaction of reactive astrocytes with injured and/or dying neurons. Few studies have focused on the signaling of astrocytes by injured neurons or on the possibility that neurons can alter astrocytic gap junctional communication. The purpose of this study was to determine whether the presence of injured neurons could alter astrocytic gap junctional coupling by establishing an in vitro method of microbeam laser neuronal injury and coculturing these neurons with astrocytes. Neurons from two rat neuronal clonal cell lines were injured using a 20-W argon laser operating on the ultraviolet (UV) multiline (351-361 nm) directed through a X40 objective of an inverted microscope. After laser injury, the glass slide with the injured neurons was sandwiched with a slide on which primary rat astrocytes were grown. Although the neurons and astrocytes were bathed in the same medium, they were not in direct contact during the coculture period (24, 48, or 72 hr). Astrocytic gap junctional dye coupling was examined using the fluorescence recovery after laser photobleaching (gap-FRAP) analysis technique. Astrocytes cocultured with the injured neurons for 24 to 48 hr did not show a significant difference in fluorescence recovery when compared to control values. After 72 hr of coculture, there was a significant increase in the gap junctional dye coupling. These results indicate that injured neurons influence in vitro astrocytic gap junctional conductance after 72 hr of coculture as measured by dye coupling.