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Sean Bryant

Publications and source records attributed to Sean Bryant.

4 recordsLinked to original sources

Visual system side effects caused by parasympathetic dysfunction after botulinum toxin type B injections.

Botulinum toxin type B (BTX-B) has been approved by the Food and Drug Administration for the treatment of cervical dystonia. However, as with botulinum toxin type A (BTX-A) it has off-label uses, such as for hyperhidrosis, focal dystonias, spasticity, and facial wrinkles. BTX-B has also been shown to be a safe and effective alternative for patients who are resistant to BTX-A. The most commonly reported side effects include dry mouth and dysphagia. To date, there have been few reports of visual disturbances associated with BTX-B use. In this study, we report on three individual patients who received BTX-B and who subsequently developed parasympathetic dysfunction of the visual system after injections of BTX-B at remote sites.

Adult↗

Characteristics of patients with no underlying toxicologic syndrome evaluated in a toxicology clinic.

BACKGROUND: A significant number of patients seek medical evaluation for chronic subjective symptoms they presume to be associated with a single toxic trigger. This report describes our clinic experience with these patients. CASE SERIES: Twenty patients (of a total of 261 patients) with a mean age of 41 years (median age 42 years; range: 4 to 65 years) were evaluated over an 8 month period. All describe a single past toxic exposure triggering their nonspecific (usually vaguely neurologic) symptoms. Zero of 20 (0%) describe other chemical sensitivities; 2/20 (10%) report ongoing exposure, 18/20 (90%) had a limited exposure dating 1 month to 6 yrs prior to toxicology clinic evaluation; 9/20 (45%) are currently employed; 6/20 (30%) sought alternative medical therapy prior to toxicologist evaluation; 6/20/(30%) have attempted litigation. CONCLUSION: Despite repeatedly normal toxicologic and medical evaluations, all data refuting an underlying toxic cause are not accepted by this series of patients, and their search for a diagnostic linkage persists. Specific toxin identification or treatment for these patients is unlikely to occur.

Adolescent↗

Management of toxic exposure in children.

Millions of children ingest household products and medications yearly. The continuous proliferation of new products and pharmaceutic agents makes it difficult for physicians to maintain a current command of toxicologic information. Multiple sources, including poison control centers, can provide information; however, EPs must be familiar with several agents that are either significant for their frequency or for their disproportionate potential for morbidity and mortality in pediatric patients. With this select group of intoxicants, physicians must anticipate cardiovascular and pulmonary instability and rapid changes in central nervous system functioning. Appropriate supportive care requires monitoring of the following: vital signs, level of consciousness, airway control, ventilation and circulatory support, body temperature, urine output, and acid base balance. Once these concerns are addressed, prevention of further absorption, enhancing a product's elimination, and treatment with specific antidotes may enhance supportive care. Care is also likely to be enhanced if the EP recognizes the inherent differences (medically and socially) between adults and children of various ages. Definitive emergency care is completed only after the provision of a developmentally oriented preventive strategy.

Adult↗