Cold-water dousing with ice massage to treat exertional heat stroke: a case series.

INTRODUCTION: We sought to determine the rate of cooling via a novel water ice therapy (WIT) as an alternative to cold-water immersion for the acute treatment of exertional heat stroke (EHS). METHODS: Observations were made at the 2004-2008 Marine Corps Marathons (mean +/- SD: 16.3 +/- 4.9 degrees C dry bulb, 32 +/- 6% RH). Nine (seven men, two women) EHS patients (33 +/- 6 yr of age; 268 +/- 54 min average race time for six who finished) were observed during on-site treatment. Patients were treated while lying supine on a porous stretcher resting on a tub filled with cold water (approximately 10-12 degrees C). Medical personnel monitored T(re), doused the patient with water and massaged major muscle groups with ice bags until T(re) decreased to 38.9 degrees C. Patients were not immersed in water. Serial T(re) and time were used to calculate cooling rates. RESULTS: Final T(re) (39.12 +/- 0.63 degrees C) was significantly lower than initial T(re) (41.43 +/- 0.71 degrees C, P < 0.05). Cooling rates were 0.13 +/- 0.04 degrees C min(-1). The decrease in T(re) for the initial 6 min of WIT (0.38 +/- 0.13 degrees C) was significantly less than for the subsequent 6-min time period (1.31 +/- 0.34 degrees C, P < 0.001). Cooling rates for these time periods were significantly different (0.06 +/- 0.02 degrees C x min(-1) and 0.22 +/- 0.06 degrees C x min(-1), respectively, P < 0.05). Initial T(re) was not correlated with overall cooling rate (r = 0.434, P = 0.244), or total cooling time required (17 +/- 4 min; r = 0.207, P = 0.593). Survival rate was 100%. CONCLUSION: WIT provided cooling rates that were 70% as effective as those published for cold-water immersion with 8 degrees C water (0.19 degrees C x min(-1)) and resulted in 100% patient survival.

Axotomy of single fluorescent nerve fibers in developing mammalian spinal cord by photoconversion of diaminobenzidine.

A technique has been developed for cutting single nerve fibers in mammalian spinal cord. In the presence of diaminobenzidine (DAB), a laser microbeam was applied to carbocyanine (Dil) stained sensory fibers in cultured spinal cords of the newly born opossum Monodelphis domestica. Digital images of fluorescent fibers were acquired with an intensified video CCD-camera coupled to an image processor. Laser illumination of two spots on a fiber in the presence of 3 mg/ml DAB cut it, so that following DAB wash out, Dil fluorescence did not return after the intermediate segment was bleached. In contrast, when a similar procedure was carried out without DAB, fluorescence of the bleached segment was recovered within minutes in darkness, by dye diffusion from adjacent regions of the uncut fiber. After exposure to DAB, through-conduction of compound action potentials continued in undamaged fibers. The DAB reaction product remained as a dark precipitate, helping to localize the lesion sites. By illuminating a continuous series of spots it was possible to cut whole nerve roots. Fluorescent fibers extended across the cut segment 24 h later. With minor modifications, the procedure described here allows a precise lesioning of single fibers within an intact nervous system.

Treatment options in overuse injuries of the knee: patellofemoral syndrome, iliotibial band syndrome, and degenerative meniscal tears.

Overuse injuries of the knee, particularly those of the extensor mechanism and iliotibial band, are commonplace in primary care and musculoskeletal practices. Effective treatment requires identification of all pertinent biomechanical factors contributing to overload and implementing measures to correct them.

Chlorhexidine-impregnated cloths to prevent skin and soft-tissue infection in Marine recruits: a cluster-randomized, double-blind, controlled effectiveness trial.

BACKGROUND: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) causes skin and soft-tissue infection (SSTI) in military recruits. OBJECTIVE: To evaluate the effectiveness of 2% chlorhexidine gluconate (CHG)-impregnated cloths in reducing rates of SSTI and S. aureus colonization among military recruits. DESIGN: A cluster-randomized (by platoon), double-blind, controlled effectiveness trial. SETTING: Marine Officer Candidate School, Quantico, Virginia, 2007. PARTICIPANTS: Military recruits. INTERVENTION: Application of CHG-impregnated or control (Comfort Bath; Sage) cloths applied over entire body thrice weekly. MEASUREMENTS: Recruits were monitored daily for SSTI. Baseline and serial nasal and/or axillary swabs were collected to assess S. aureus colonization. RESULTS: Of 1,562 subjects enrolled, 781 (from 23 platoons) underwent CHG-impregnated cloth application and 781 (from 21 platoons) underwent control cloth application. The rate of compliance (defined as application of 50% or more of wipes) at 2 weeks was similar (CHG group, 63%; control group, 67%) and decreased over the 6-week period. The mean 6-week SSTI rate in the CHG-impregnated cloth group was 0.094, compared with 0.071 in the control group (analysis of variance model rate difference, 0.025 ± 0.016; P = .14). At baseline, 43% of subjects were colonized with methicillin-susceptible S. aureus (MSSA), and 2.1% were colonized with MRSA. The mean incidence of colonization with MSSA was 50% and 61% (P = .026) and with MRSA was 2.6% and 6.0% (P = .034) for the CHG-impregnated and control cloth groups, respectively. CONCLUSIONS: CHG-impregnated cloths applied thrice weekly did not reduce rates of SSTI among recruits. S. aureus colonization rates increased in both groups but to a lesser extent in those assigned to the CHG-impregnated cloth intervention. Antecedent S. aureus colonization was not a risk factor for SSTI. Additional studies are needed to identify effective measures for preventing SSTI among military recruits. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov identifier: NCT00475930.