Poisoning, envenomation, and trauma from marine creatures

In the course of their clinical work or during leisure activity, family physicians occasionally may encounter patients with injuries from marine creatures. Poisoning, envenomation, and direct trauma are all possible in the marine environment. Ciguatera poisoning can result from ingestion of predatory fish that have accumulated biotoxins. Symptoms can be gastrointestinal or neurologic, or mixed. Management is mostly symptomatic. Scombroid poisoning results from ingestion of fish in which histamine-like substances have developed because of improper refrigeration. Gastrointestinal and systemic symptoms occur. Treatment is based on antihistamines. Envenomations from jellyfish in U.S. waters and the Caribbean are painful but rarely deadly. Household vinegar deactivates the nematocysts, and manual removal of tentacles is important. Treatment is symptomatic. Heat immersion may help with the pain. Stingrays cause localized damage and a typically severe envenomation. The venom is deactivated by heat. The stingray spine, including the venom gland, typically is difficult to remove from the victim, and radiographs may be necessary to localize the spine or fragment. Surgical débridement occasionally is needed. Direct trauma can result from contact with marine creatures. Hemorrhage and tissue damage occasionally are severe. Infections with organisms unique to the marine environment are possible; antibiotic choices are based on location and type of injury. Shark attacks, although rare, require immediate attention.

Trisomy 5 as sole anomaly in acute lymphoblastic leukemia

We present a case of B-cell acute lymphoblastic leukemia (ALL) in whose leukemic cells trisomy 5 (+5) was the only cytogenetic anomaly observed. This is the first report of +5 as the sole cytogenetic abnormality in ALL; two cases (one questionable) of acute nonlymphocytic leukemia with such a change have been reported. The findings are presented in relation to other cases with +5 as part of a more complicated cytogenetic picture in hematologic disorders.

Fragile sites at 4q23 and 7q11.23 unique to bone marrow cells

Fragile sites in chromosome bands 4q23 and 7q11.23 were discovered in bone marrow cells. Expression of these fragile sites was induced by treatment of the cells sequentially with 10(-7) M methotrexate and then 10(-5) M thymidine. No expression was observed in bone marrow cells without treatment. The fragile sites at 4q23 and 7q11.23 were seen individually, together, and in the homozygous state in a total of 20 bone marrow samples. The bone marrow karyotypes were normal in all cases. Expression of these common fragile sites at 4q23 and 7q11.23 could not be induced in blood lymphocytes from two subjects using methotrexate and thymidine, or by any other means including the addition of bromodeoxyuridine and fluoro-deoxyuridine or growth in folate-deficient medium. Because the fragile sites at 4q23 and 7q11.23 have never been observed in lymphocytes treated with methotrexate and thymidine for high-resolution chromosome analysis, it appears that these fragile sites are not expressed under these conditions in T lymphocytes. We propose that the differential expression of these fragile sites in bone marrow cells reflects genes active in bone marrow cells but not in blood lymphocytes.

Enhanced expression of chromosome fragile site 10q25 in chronic myelogenous leukemia

Spontaneous expression of a BrdU-sensitive fragile site at 10q25 was observed in normal lymphocytes and malignant blood and bone marrow cells in chronic myelogenous leukemia (CML). The cells were marked by a Philadelphia chromosome rearrangement due to insertion of 22q11----q13 at 11q13. The fragile site at 10q25 was expressed in larger proportions of malignant than normal cells. Although this fragile site is not at a cancer chromosome breakpoint, malignancy enhanced its expression, consistent with a cascade effect.

Euryblepharon: a case report with photographs documenting the condition from infancy to adulthood

A case of euryblepharon with lateral ectropion is reported, with photographs from infancy to adult life. The value of obtaining photographs, if available, in cases such as this is stressed, to avoid unnecessary clinical studies being done. The photographs indicate the stability of the condition. They also indicate that, at least in some cases, the ectropion will become less apparent with body growth and may need no therapy.