Biomedical subjects
M Cherington
Publications and source records attributed to M Cherington.
Mountain medical mystery. Unwitnessed death of a healthy young man, caused by lightning.
A healthy 20-year-old man failed to return home after a jog in the Colorado mountains. His lifeless body was found the next day on an exposed mountain slope. The differential diagnosis in such mysterious, unwitnessed mountain deaths includes cardiac arrhythmia, cerebral hemorrhage, pulmonary embolism, seizures, trauma, high-altitude sickness, and hypothermia. The cause of death in this case was established on postmortem examination. The findings of ruptured tympanic membranes and a melted shoe established this as a case of lightning strike fatality. The National Lightning Detection Network can be a valuable resource to investigators by providing information on the location and date of lightning strikes in the vicinity of the victim.
Lightning injuries in sports: situations to avoid.
There is no absolute protection against lightning because of its random and capricious nature. However, the risk of being struck by lightning can be substantially reduced. There are general safety rules that apply to all athletic and recreational events. The athlete should have a proactive plan that can be instituted when storms approach. He/she should go to a safe shelter before the storm arrives and stay there until the danger is gone. Because the location, climate, terrain and playing site vary with different sporting activities, safety plans may have distinct elements for different recreational activities. Mountain climbers should know the weather patterns of their locale. The highest frequency of lightning strikes in the Rocky Mountains occurs between 11 am and 9 pm during the months of April to September. There is less chance of a hiker encountering lightning during the early morning hours. Many tourists are unaware of this pattern, which may possibly explain the finding that most lightning victims are visitors from other states. The bicyclist is as vulnerable as anyone in the open. In the event of lightning he/she should seek safe shelter and get off the bike. Rubber tires do not provide protection from lightning. Golfers continue to make the same mistakes year after year. Golfers should know to seek safe shelter (clubhouse or closed metal vehicle) before the storm arrives and not return prematurely to the golf course. They should avoid isolated trees, open fields, unsafe sheds and metal poles. They should separate from each other rather than gather together. Swimmers should get out of the pool and find a safe shelter. Safe areas do not include poolsides, under awnings or under trees. A nearby closed automobile may be the safest place until the danger is gone. Applying precautions when engaging in these sporting or recreational activities will help to minimise the risk of casualties or fatalities caused by lightning.
The lower plexus innervates the opponens pollicis and abductor pollicis brevis.
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Hazards of bicycling: from handlebars to lightning.
The bicycle, an invention that provides joy and transportation to millions of people, can also be a source of disabling injuries and death. The victims of bicycle accidents are usually in good health and often young. Most of the fatal head injury cases are teenagers. In this article, I have chosen four areas of bicycle trauma that frequently brings the bicycle patient to the attention of a neurologist. These areas are (1) head trauma as a consequence of road collisions; (2) compressive ulnar neuropathy; (3) impotence, probably due to compression of the pudendal nerve or its branches; and (4) lightning-related bicycle injuries. The one thing that all four categories have in common is that they are often preventable. Helmet usage and common sense would lower the number of serious head trauma cases by 50%. Compressive ulnar and pudendal neuropathies can be prevented or reduced if the cyclist would frequently change his or her position in relation to the handlebar and saddle. In the majority of cases of compressive neuropathies, the symptoms improve if the patient takes a holiday from bike riding. Lightning injuries can be avoided or lessened if the cyclist takes proactive measures to limit his or her exposure during thunderstorms. These proactive measures include knowing the climate patterns of the area and knowing where the nearest safe shelter is located.
Neurovascular compression in the thoracic outlet syndrome.
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Diagnosing upper plexus thoracic outlet syndrome with median motor nerve conduction studies.
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The life, legacy, and premature death of Felix Mendelssohn.
Felix Mendelssohn is one of the great classical composers of all time. During his short lifetime in the first half of the nineteenth century, he reached enormous heights as a composer, conductor, and leader in the world of music. Nearly one hundred years after his death, the Nazi regime attempted, unsuccessfully, to erase his music and his memory from history. Since the end of World War II, there has been a resurgence in interest in the life and music of Felix Mendelssohn and that of his sister, Fanny. Felix Mendelssohn died in 1947 at the age of 38. Both of his sisters died suddenly at the ages of 42 and 45. There is insufficient laboratory or post-mortem data to make a medical diagnosis with certainty. However, based on the information available to us, we speculate that Mendelssohn suffered a subarachnoid or intracerebral hemorrhage. The differential diagnosis of familial stroke syndrome is discussed.
Could lightning injury be magnetically induced?
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Clinical spectrum of botulism.
Botulism is a paralyzing disease caused by the toxin of Clostridium botulinum. The toxin produces skeletal muscle paralysis by producing a presynaptic blockade to the release of acetylcholine. Recent studies have pinpointed the site of action of the several types of botulinum neurotoxin at the nerve terminal. Since the discovery of the toxin about 100 years ago, five clinical forms of botulism have been described: 1) classic or foodborne botulism; 2) wound botulism; 3) infant botulism; 4) hidden botulism; 5) inadvertent botulism. A clinical pattern of descending weakness is characteristic of all five forms. Almost all human cases of botulism are caused by one of three serotypes (A, B, or E). Classic and wound botulism were the only two forms known until the last quarter of this century. Wound botulism was rare until the past decade. Now there are increasing numbers of cases of wound botulism in injecting drug users. Infant botulism, first described in 1976, is now the most frequently reported form. In infant botulism spores of Clostridium botulinum are ingested and germinate in the intestinal tract. Hidden botulism, the adult variant of infant botulism, occurs in adult patients who usually have an abnormality of the intestinal tract that allows colonization by Clostridium botulinum. Inadvertent botulism is the most recent form to be described. It occurs in patients who have been treated with injections of botulinum toxin for dystonic and other movement disorders. Laboratory proof of botulism is established with the detection of toxin in the patient's serum, stool, or wound. The detection of Clostridium botulinum bacteria in the stool or wound should also be considered evidence of clinical botulism. Electrophysiologic studies can provide presumptive of botulism in patients with the clinical signs of botulism. Electrophysiologic testing can be especially helpful when bioassay studies are negative. The most consistent electrophysiologic abnormality is a small evoked muscle action potential in response to a single supramaximal nerve stimulus in a clinically affected muscle. Posttetanic facilitation can be found in some affected muscles. Single-fiber EMG studies typically reveal increased jitter and blocking, which become less marked following activation. The major treatment for severe botulism is advance medical and nursing supportive care with special attention to respiratory status.
Lightning injuries during snowy conditions.
Skiers and other snow sports enthusiasts can become lightning casualties. Two such accidents are reported, one being fatal. There are fewer warning signals of impending lightning strikes in winter-like conditions. However, outdoor activists should be aware of at least two suspicious clues: the appearance of convective clouds, and the presence of graupel (snow pellets) during precipitation.
A bolt from the blue: lightning strike to the head.
We report an extraordinary event of a lightning strike to the head of a helmeted bicyclist that occurred under fair weather conditions with a cloudless sky. The patient sustained a cardiac arrest and hypoxic encephalopathy with residual neurologic impairment. With the availability of highly developed meteorologic equipment, we were able to determine that the lightning "bolt from the blue" probably originated in a thunderstorm that was about 16 km away and obscured by the mountains.
Neurology's witness to history.
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More on MRI of lightning injury.
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Central nervous system complications of lightning and electrical injuries.
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Lightning and transportation.
It is a little-known fact that lightning casualties often involve travel or transportation. López and colleagues, in their studies on the epidemiology of lightning injuries, have reported that 10% of lightning injuries are categorized under transportation. In the majority of their cases, victims were struck while standing outside or near their vehicles during a thunderstorm. During my review of the neurologic complications of lightning injuries, I was impressed by the number of case reports in which the victim was struck while either in or near a vehicle, airplane or vessel. In this article, I shall put forth information on four aspects of lightning that relate to the danger to people traveling in vehicles, boats, and airplanes. First, I shall deal with lightning safety on ships and boats. People who enjoy recreational sailing, including the "weekend sailor" and those who enjoy fishing from a boat, should be fortified with knowledge about lightning protection. Second, I shall consider the matter of lightning strikes to aircraft. In the third section, I shall discuss the question of lightning safety in automobiles. Fourth, I shall review those cases found in my literature review in which the victim was struck while in or near a vehicle, boat, or airplane.